Failed distractional bone regeneration as a complication of distraction osteosynthesis: risk factors, preventive diagnosis, treatment

Abstract

Introduction Despite the large number of articles on complications associated with surgical lengthening, information about such a complication of transosseous distraction osteosynthesis as failed bone regenerate (called hypoplastic in foreign literature) is extremely rare. There are no methods for predicting the restructuring of the regenerate and clinical recommendations for the management of patients at various stages of reconstruction of the distraction regenerate. This entails a long period of immobilization and severe complications. The objective of the work was to define the notion of inadequate (“ischemic”/hypoplastic) bone regeneration and the problem of its formation as a complication during surgical limb lengthening Material and methods The PubMed database and the eLIBRARY scientific electronic library were used to select sources for a systematic literature review. The sources published between 1997 and 2020 were selected Results and discussion Ineffective distraction bone regenerate is a complication of surgical segment lengthening with the shape and/or structure of the newly formed bone preventing functional load on the segment. There is a general tendency with bone elongations being greater than 15-20 % to significantly reduce biomechanical properties of the distractional regenerate bone. Patients' age at surgical lengthening is not reported as a risk factor for distraction regenerate fractures and a history of adverse events and complications is regarded as an additional risk factor. Inadequate (unstable) distraction regenerate bone includes morphotypes III-V and structural types 1, 5, 7 as classified by Ru Li. There are no clinical guidelines for operational strategy. Failed distraction bone regeneration as a complication of distraction osteosynthesis was reported by different authors between 1997 and 2020. There are conflicting statistically unreliable data regarding a risk for regenerate bone to develop into a less stable type. The surgical options presented have no statistical significance (occasional case reports) and do not describe all possible clinical scenarios. Conclusion The problem of failed distraction regeneration and impaired organotypic restructuring remains one of the most important problems in limb lengthening. Inadequate formation and restructuring of newly formed bone can be caused by many factors including anatomical, physiological and technological aspects that would require further comprehensive study.

Keywords

• hypoplastic/ischemic/atrophic distractional regenerate bone
• complications of distraction osteosynthesis
• classification of distraction regenerate bone