Tayyab Shoaib, Usman Zafar Dar, Syed Asif Ali, Muhammad Ali, Yasir Iqbal, Rashid Hussain.
Etiology of shortened leg and its associations in patients who underwent tibial lengthening surgery using NA external fixator.
J Allama Iqbal Med Coll Jan ;19(4):894-8.

Objectives: To determine the etiologies of leg shortening in our patients at GMC, Gujranwala, and KEMU, Lahore, Pakistan. In addition, this study will also find significant factors of NA fixator-assisted lengthening surgery associated with the etiology of leg shortening in the studied population. Methods: A cross-sectional analysis of the patients having short leg who underwent tibial lengthening procedure using NA external fixator was performed. These patients were categorized into two etiological groups: post-polio and post-trauma. 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 etiology of shortened leg. The p-values were taken statistically significant if < 0.05. Results: Out of the total of 100 short leg patients, etiology was neurological in 88% and post-trauma in 12% patients. The mean age of the post-polio patients was 17.59 + 6.50 years while the mean age of post-trauma patients was 21.83 + 16.55 years. The post-polio patients were young as compared to post-trauma patients (p=0.048). Significantly a greater number of pins had to be inserted during lengthening procedure in post-trauma patients as compared to post-polio patients. (8.00 + 1.35 vs 6.52 + 1.26, p<0.01). In 83.33% (10 out of 12) post-trauma patients, plaster had to be applied on fixator removal while in 56.81% (50 out of 88) post-polio patients, plaster had to be applied on fixator removal. The etiology of shortened leg in patients who underwent tibial lengthening procedure using NA external fixator had insignificant association with the gender of the patients (p=0.539), duration of hospitalization (p=0.975), the duration of external fixation (p=0.975), healing time (p=0.304), side of affected limb (0.555), site of tibial osteotomy (p=0.504), complications of external fixator (p=0.617), skin reaction to pins (p=0.617), type of bone healing (p=0.455), and post-healing discomfort (p=0.502). Conclusion: The commonest etiology of shortened leg was neurological especially poliomyelitis in our studied population. The post-polio patients were young as compared to post-trauma patients. Significantly a greater number of pins had to be inserted during lengthening procedure in post-trauma patients as compared to post-polio patients. The plaster had to be applied on fixator removal more likely in post-trauma patients as compared to post-polio patients. The etiology of shortened leg in patients who underwent tibial lengthening procedure using NA external fixator had insignificant association with the gender of the patients, duration of hospitalization, the duration of external fixation, healing time, side of affected limb, site of tibial osteotomy, complications of external fixator, skin reaction to pins, type of bone healing, and post-healing discomfort. Keywords: Short Tibia, Tibial lengthening surgery, NA external fixator, etiology, SPSS

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