Usman Zafar Dar, Muhammad Ali, Syed Asif Ali, Rashid Hussain, Shahzad Anjum, Tayyab Shoaib.
Role of site of osteotomy in tibial lengthening surgery using na external fixator.
J Allama Iqbal Med Coll Jan ;19(4):889-93.

Objectives: To determine the role of the site of osteotomy in tibial lengthening surgery using NA external fixator, and to compare the two different osteotomy sites in term of different qualitative and quantitative parameters in our patients at GMC, Gujranwala, Pakistan. Methods: This cross-sectional analysis include patients having short tibia who underwent tibial lengthening procedure using NA external fixator. These patients were categorized into two groups: Proximal tibial osteotomy group and middle tibial osteotomy group. Statistical analysis was done using SPSS version 25. Independent sample T test and Chi-square test for independence were used for quantitative and qualitative variables respectively to determine their significant association with the site of tibial osteotomy used during lengthening procedure. The p-values were taken statistically significant if < 0.05. Results: Amongst 100 patients, osteotomy site was proximal metaphysis in 74% and mid-tibia in 26% patients. The mean age of these two group patients was 18.19 + 7.59 years and 17.85 + 10.34 years respectively. The mean number of pins inserted during tibial lengthening procedure when site of osteotomy was proximal metaphysis was 7.08 + 0.92, while the mean number of pins inserted during tibial lengthening procedure when site of osteotomy was mid-tibia was 5.62 + 1.77. Significantly greater number of pins had to be inserted when osteotomy site was proximal metaphysis (p<0.01). There was insignificant association of the site of osteotomy with duration of hospitalization (4.95 + 3.76 days vs 5.92 + 4.11days, p=0.268), duration of external fixation (255.11 + 97.66days vs 299.92 + 181.14days, p=0.117), and time of healing (315.43 +121.54 days vs 317.54 + 212.99days, p=0.951). The rate of skin reaction to fixator pins was significantly more in mid-tibial osteotomy patients as compared to proximal metaphyseal osteotomy patients (69.2% vs 45.9%, p=0.034). Similarly, the rate of post-healing pain /discomfort was significantly more in mid-tibial osteotomy patients as compared to proximal metaphyseal osteotomy patients (84.6% vs 64.9%, p=0.047). There was statistically insignificant association of the site of osteotomy with the gender of the patients (p=0.582), cause of shortening of leg (p=0.504), side of affected limb (p=0.240), bone grafting during lengthening procedure (p=0.119), and complications of external fixator (p=0.230) Conclusion: Proximal metaphysis was the site of osteotomy among majority patients who underwent tibial lengthening procedure at our institute. Significantly greater number of pins had to be inserted when osteotomy site was proximal metaphysis as compared to mid-tibia. Similarly, Skin reaction to fixator pins as well as post-healing pain were significantly more common in mid-tibial osteotomy patients. There was statistically insignificant association of the site of osteotomy with the gender of the patients, duration of hospitalization, duration of external fixation, time of healing, cause of shortening of leg, side of affected limb, bone grafting during lengthening procedure, and complications of external fixator.

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