Talk:Distraction osteogenesis/Archive 1

Images from fracture article
Maybe these images from bone fracture can be used here:  — Preceding unsigned comment added by BMF81 (talk • contribs) 07:01, 21 December 2006 (UTC)

Copyviol
The first version of this article, made by User_talk:PM_Poon, seem to copyviol (in the lead section) of this.--BMF81 18:30, 7 January 2007 (UTC)

Fair use rationale for Image:Fitbone surgery.jpg
Image:Fitbone surgery.jpg is being used on this article. I notice the image page specifies that the image is being used under fair use but there is no explanation or rationale as to why its use in this Wikipedia article constitutes fair use. In addition to the boilerplate fair use template, you must also write out on the image description page a specific explanation or rationale for why using this image in each article is consistent with fair use.

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BetacommandBot (talk) 20:34, 13 February 2008 (UTC)

Fair use rationale for Image:Ilizarov surgery.jpg
Image:Ilizarov surgery.jpg is being used on this article. I notice the image page specifies that the image is being used under fair use but there is no explanation or rationale as to why its use in this Wikipedia article constitutes fair use. In addition to the boilerplate fair use template, you must also write out on the image description page a specific explanation or rationale for why using this image in each article is consistent with fair use.

Please go to the image description page and edit it to include a fair use rationale. Using one of the templates at Fair use rationale guideline is an easy way to ensure that your image is in compliance with Wikipedia policy, but remember that you must complete the template. Do not simply insert a blank template on an image page.

If there is other fair use media, consider checking that you have specified the fair use rationale on the other images used on this page. Note that any fair use images lacking such an explanation can be deleted one week after being tagged, as described on criteria for speedy deletion. If you have any questions please ask them at the Media copyright questions page. Thank you.

BetacommandBot (talk) 22:27, 13 February 2008 (UTC)

Links
There is nothing wrong with any of the external links posted. Who flagged this???70.187.60.53 (talk) 23:45, 8 October 2008 (UTC)


 * There were far too many of them. Wikipedia is not a link directory. I took a few links out, but more can probably be removed. Graham 87 06:36, 26 February 2009 (UTC)


 * Wiki articles "Limb lengthening methods" and "Distraction osteogenesis" are added to each other well. Therefore, it makes sense to link these articles mutually.Dimmando (talk) 13:14, 18 May 2013 (UTC)


 * Thanks; I've made the link use the template See also, but I've removed the imbedded link you added because that's not how we do things here. Graham 87 14:58, 18 May 2013 (UTC)

Additions, edit required
Added some current information on intramedullary devices, added a paragraph on Ilizarov derivatives and edited some of the Fitbone material which still requires significant fixing - far too marketing oriented. —Preceding unsigned comment added by 84.228.176.125 (talk) 23:21, 25 October 2010 (UTC)


 * Sounds good to me. Graham 87 01:22, 26 October 2010 (UTC)


 * More sources (non primary, MEDRS) and some substantial trimming are still needed. - - MrBill3 (talk) 06:17, 17 November 2014 (UTC)

PROMO section needs repair
moving this here for repair before we re-add it - badly sourced and promotional


 * Fitbone surgery

A form of surgery involving an intramedullar, fully implantable, electronically-motorised limb-lengthening implant, called "Fitbone", is a technologically advanced, though relatively complex, device.

Developed in Germany by Augustin Betz and Rainer Baumgart, the first successful operations were performed in 1996 and the technique was patented in 1997. Thus far, most of the surgeries using this method have been performed in Munich, Germany by Baumgart and Peter Thaller. The first successful surgeries in Asia have been performed since 2001 by Sarbjit Singh in Tan Tock Seng Hospital, Singapore, and Sittiporn, Bumrungrad Hospital, Bangkok. In December 2005 Fitbone surgery was done in Malaysia at the Mahkota Orthopaedic Reconstruction and Limb Lengthening Center, Melaka by Thirukumaran Subramaniam and Jeyaratnam T Satkunasingam. Bruce Foster of Adelaide, Australia, chairman of the "Bone Growth Foundation" — a charity established with the aim of helping children with crippling bone growth problems — is currently the only surgeon that uses the "Fitbone" device in the southern hemisphere.

Fitbone comprises a telescopic nail implant that can extend, powered by an electric motor and controlled by a receiver with an antenna that is buried under the skin; the receiver in turn is controlled by a hand-held radio-frequency transmitter. The procedure for lengthening the lower leg is as follows:
 * A two-centimetre incision is made at the patient's knee, and a reamer is used to create enough space in the bone for a stainless steel nail.
 * The bone is cut about 14 cm below the knee from the inside with an internal saw.
 * The stainless steel nail is held in place by two screws. The top of the nail is attached to a tiny, plastic-encased receiver that is placed under the skin.
 * The patient controls the lengthening process. By pushing a button on the transmitter when it is placed against the antenna, the built-in motor extends the nail one millimetre per day. When the leg has grown to the desired length, lengthening stops, and the bone is allowed to solidify.
 * The device can be removed about two years after the initial surgery.

This procedure, however, comes at a price. While the Ilizarov external fixator costs approximately US$4,000, and the ISKD implant about US$8,000, the Fitbone device carries a price tag of roughly US$15,000 (all prices exclusive of surgery costs).

The Bliskunov device is currently not available.

needs fixing Jytdog (talk) 14:10, 27 August 2015 (UTC)

Needs review for sourcing and NPOV
I removed this from the article and put it here, until it can be reviewed for NPOV and sourcing. It is not fit to in mainspace as it stands.

Using exclusively an external fixator
The most common is the Ilizarov surgery with the Ilizarov external fixator. Other methods include Wagner, and Judet, and equipment such as the Taylor Spatial Frame and TrueLok Hex. Helong Bai (8th Hospital in Chongqing, China) developed the technique "Micro-wound" with a different apparatus.

Ilizarov surgery
Ilizarov surgery, developed by Gavriil Ilizarov, a Russian orthopedic surgeon, in 1951, is the oldest and most common method of distraction osteogenesis. It often brings complications, while some new methods have a much lower rate of complications.

The process involves the following:
 * Shattered and devascularised bones are removed from the patient, leaving a gap;
 * The healthy part of the upper bone is broken into two segments with an external saw;
 * The leg is then fitted with the Ilizarov frame that pierces through the skin, muscles, and bone;
 * Screws attached to the middle bone are turned 1 millimetre (mm) per day, so that new bone tissues that are formed in the growth zone are gradually pulled apart to increase the gap. (One millimetre has been found to be the optimal bone distraction rate. Lengthening too fast overstretches the soft tissues, resulting not only in pain, but also in the inability of the bone to fill up the gap; too slow, and the bone hardens before the full lengthening process is complete.)
 * After the gap is closed, the patient continues to wear the frame until the new bone solidifies; the waiting period before the frame can be removed is usually one month per centimetre of lengthened bone.



Ilizarov surgery is extremely painful, uncomfortable, infection-prone, and often causes unsightly scars . Frames used to be made of stainless steel rings weighing up to 7 kilogram (kg), but newer models are made of carbon fiber reinforced plastic, which though lighter, are equally cumbersome.

Derivative devices provide physicians better control over the bone axis and angle during elongation, such as the Taylor Spatial Frame (TSF) which is computer assisted. The downside of these developments are their relative complexity and resulting longer learning curve.

For decades, the Ilizarov procedure was the best chance for shattered bones to be restored, and crooked ones straightened. Breakthroughs in distraction osteogenesis in the 1990s, however, have resulted in less painful (albeit more expensive) alternatives, such as unilateral rails.

Using exclusively an intramedullary nail
The techniques that use an intramedullary nail without an external fixator are: Albizzia, Bliskunov-Dragan, Guichet, Fitbone and ISKD.

The Guichet Method
Invented in 1987 by Jean-Marc Guichet, the Albizzia nail was created during his residency at the University Center (CHU) of Dijon, France. The Albizzia nail is inserted into the bone canal after it is calibrated with a reamer. The nail is then fixed to the ends of the bone fragments with screws. The nail consists of two sliding tubes that rotate in relation to the other, allowing for the nail to extend through a series of “clicks.” After insertion, the patient “clicks” the nail by turning the knee and leg (femoral nail) or foot (tibial nail) alternating inward and outward rotations to gradually lengthen. 15 clicks per day results in 1mm of gain. Expansions of up to 10 cm have been reported. The Albizzia nail is used in almost 30 countries and over 3,000 nails have been implanted.

In 2009, Guichet patented the Guichet Nail. The Guichet Nail is an improved version of the Albizzia nail because it uses stronger steel that allows for full weight bearing activity almost immediately after surgery. Furthermore, the Guichet Nail is customizable for size to ensure maximum comfort and efficiency for patients with smaller bones. Although there is initial pain after the surgery and during the clicks, the Guichet Nail is believed to be less painful than other methods as it is less invasive. Furthermore, as the patient controls the method of “clicking,” the patient is able to reduce pain by determining the most suitable method for themselves.

Intramedullary skeletal kinetic distractor
In 2001, the "Intramedullary skeletal kinetic distractor" (ISKD) was introduced, allowing lengthening to take place internally, thereby drastically reducing the risk of infections and scarring. The ISKD device was designed by J. Dean Cole of Orlando, Florida.

With ISKD, a telescopic rod that can be gradually extended by knee or ankle rotations is implanted into the bone. Lengthening is monitored by a hand-held external magnetic sensor that tracks the rotation of an internal magnet on a daily basis.

ISKD requires a physical leg movement to "click" the device into lengthening. In this method, there is no risk of accidentally over-stretching the bone due to the lengthener being preset to the desired fully extended length. However, there is a risk of growing the bone too quickly. Bone growth is monitored by measuring changes in the magnetic field of an embedded magnet in the system. The poles of the magnet change as the device grows. However, if the motion of the leg makes the device grow too quickly, and the magnet switches poles twice between measurements, then that growth is not recorded. This leads to overly rapid growth which can cause a number of issues such as nerve damage or causing breaks in the bone.

While there is some pain associated with the immediate post-op lengthening, the initial lengthening procedure is not to begin until one week after surgery. Furthermore, there is no noticeable "click" to the patient as there is less than nine degrees of rotation of the two bone segments in relation to one another.

Regularly used at a handful of medical centers mostly in the United States, only several dozens of ISKD devices are implanted each year. An improved version is currently being developed by its manufacturer (Orthofix).

Future technology
Due to shortcomings of current external and internal devices and the evident market potential of cosmetic limb elongation, a growing number of companies are researching potential intramedullary technologies. These include:
 * Concepts based on electromagnetic actuation
 * Concepts based on smart material integration
 * Concepts based on manual actuation
 * Concepts based on electronic actuation

Biotechnological advances, such as in stem cell research, may become the next generation standard of care for limb elongation once it matures.

- Jytdog (talk) 08:01, 15 February 2016 (UTC)

WP:OR
The following appears to be WP:OR

Possible uses of distraction osteogenesis
Although distraction osteogenesis is most often used in the treatment of post-traumatic injuries, it is increasingly used to correct limb discrepancies caused by congenital conditions and old injuries. A list of the possible uses of distraction osteogenesis are as follows:
 * Congenital deformities (birth defects):
 * Congenital short femur.
 * Fibular hemimelia (absence of the fibula, which is one of the two bones between the knee and the ankle).
 * Hemihypertrophy (a rare genetic condition in which growth is greater on one side of the body. This can be complete (everything from the bone to the skin on one entire half of the body) or partial (just one leg or arm).
 * Ollier's disease.
 * Developmental deformities
 * Neurofibromatosis (a rare condition which causes overgrowth in one leg); and
 * Bow legs, resulting from rickets or secondary arthritis.
 * Post-traumatic injuries
 * Growth plates fractures;
 * Malunion or non-union (when bones do not completely join, or join in a faulty position after a fracture);
 * Shortening and deformity; and
 * Bone defects.
 * Infections and diseases
 * Osteomyelitis (a bone infection, usually caused by bacteria);
 * Septic arthritis (infections or bacterial arthritis); and
 * Poliomyelitis (a viral disease which may result in the atrophy of muscles, causing permanent deformity).
 * After tumors
 * Short stature
 * Achondroplasia (a form of dwarfism where arms and legs are very short, but torso is more normal in size); and
 * Constitutional short stature.

Cosmetic lengthening of limbs
Generally, doctors tend to discourage cosmetic lengthening for people who want to add a couple of inches to their frames because such people are:
 * breaking perfectly functional limbs;
 * confining themselves unnecessarily to crutches or a wheelchair for over a year;
 * voluntarily subjecting themselves to pain and discomfort;
 * exposing themselves to unnecessary risk of infections, of damaged nerves and blood vessels, and fat embolism that can result in death; and
 * incurring unnecessary expenses as the procedure is relatively expensive.

People insistent on doing the procedure, however, are required by some doctors to undergo a thorough body image assessment by a psychologist to help determine how far the person's quality of life has been affected by his perceived lack of height, and if doing the surgery will make a marked difference.

-Jytdog (talk) 08:03, 15 February 2016 (UTC)

WP:CRYSTALBALL and WP:OR
The following needs to be reviewed

Maxillofacial distraction osteogenesis
Correcting the majority of congenital craniofacial defects, as well as some facial injuries resulting from trauma, requires making bones longer. Distraction osteogenesis is an effective way to grow new bone, but it is much more difficult to accomplish in the face than in other areas of the body. Bones must often be moved in three dimensions, as opposed to just one, as in a limb, and scarring must be kept to a minimum. Researchers are attempting to improve the distraction devices used in the face. Until recently, the mechanisms were external and only operated along straight lines. Now, maxillofacial surgeons can use curvilinear devices capable of moving bone in three dimensions.

These new devices still need to be improved. They depend on patient caretakers reliably turning a screw. The next goal is to create devices that will move bone continuously, not in daily increments of 1 mm. These continuously moving devices would cause less pain, wouldn’t require daily patient compliance, and might promote faster bone growth. At the moment, researchers are testing a continuously moving device in animal models, and they have found that the device’s components are durable, that its user interface works, and that it is tolerated by the body. When the position sensor in the device is perfected, the device will be ready to use in people.

In distraction osteogenesis procedures involving the face, it is critical that bone movements be carefully planned before a device is implanted. No existing device is capable of changing its trajectory mid-course, and small skeletal changes lead to large changes in the structure of the face. Recently researchers have developed state-of-the-art software capable of simulating the entire process of distraction osteogenesis. The 3-D planning tool uses data from CT scans to create a segmented model of the patient’s skull, and it then calculates the vector of movement required to achieve desirable bone positioning. Outcome CT scans can be overlaid on the original model to assess the effectiveness of the procedure. In the future, researchers hope that the distraction devices used in maxillofacial procedures will continue to improve, along with the corresponding software.

- Jytdog (talk) 08:05, 15 February 2016 (UTC)

Update
Worked this over using recent MEDRS sources, clearing out the old cruft. There are still a lot of reviews I haven't tapped, per the results of using the link at the top of this page. Done for now. Jytdog (talk) 06:22, 1 November 2016 (UTC)