If we osteotomize (cut transversely) a well-vascularized bone, we keep the osteotomy focus at rest for a week (fracture created - start of consolidation) and later we “stretch” (we distract) 1 mm, per day of the fracture repair callus, Thanks to "stretching-distraction", we will obtain the formation of a bone with morphological characteristics equal to that of a "normal" bone. The ability to obtain tubular bone will depend on multiple factors that the treating specialist must take into consideration. We are reconstructing a new "normal" bone originated by "distraction osteogenesis" (OD).
Added values of distraction osteogenesis In the continuity of care of more than two hundred distraction osteogenesis processes carried out personally in my care practice, for the treatment of multiple pathologies, I have been able to verify the goodness of the method. In a constant way the O.D. process is associated with:
• The entire bone segment treated by O.D. it is hypervascularized, this hypervascularization is not limited to the bone segment that is the object of treatment, it extends to the entire treated extremity, this is due to the stimulus exerted on vasculogenesis (creation of new vessels) caused by the automatic attempt at self-repair. This is of great interest due to the benefit produced by the increase in vascularity, on the processes of reconstruction and protection against infection through the stimulation of the formation and contribution of protective immunological factors, among others, against septic processes.
• The method provides a tubular morphology to the new regenerate, mechanically the lightest form and the most mechanically resistant.
• The surgical technique itself allows correction of associated deformations, shortening, angular and rotational deformations.
• Possibility of skeletal reconstruction even without the help or coverage of soft tissues, an extreme undesirable situation.
Distraction osteogenesis is not a term of recent appearance as it was coined by Gavriil Ilzarov in 1945, but the therapeutic resources developed thanks to this methodology are current and allow solving difficult problems and classically accepted in many cases as irreversible.
One of them, chronic osteitis. Thanks to segmental bone resection techniques (remove a bone fragment) as a radical solution to eliminate infected bone, we can talk about eradicating osteitis permanently and permanently. Complications arising in the evolution of fractures such as septic pseudoarthrosis or malpositioned malunions can also benefit from segmental bone resection and subsequent reconstruction by distraction osteogenesis (OD).
Bone loss due to accidents, with severe open fractures and removal of bone fragments through the traumatic wound associated with infection, are incompatible with conventional surgical reconstruction techniques. Bone transportation through distraction osteogenesis (OD) makes reconstruction possible, allowing the limbs to equalize in length, avoiding asymmetric shortening.
Bone transportation is an easy solution for reconstruction of a traumatic limb, and is based on a "local lengthening" technique to cover the bone defect, as seen in the attached images. Method of choice in the reconstructive solution of bone loss due to therapeutic surgical resection of bone fragments affected by neoplasia pathology, although in these cases important factors must be considered such as: prognosis of the pathology, immune status of the patient, associated chemotherapy treatment.
Distraction Osteogenesis (DO) is the term used to describe the ability of properly vascularized bone to form new bone at the expense of “stretching its fracture callus”, that is, once a fracture has been created in a bone (through an osteotomy).
In our hands, the proposed method is very safe with a high success rate in the treatment of challenging pathologies. Incomprehensibly it is a method little known by the general population. Despite current trends, we prefer “monolateral” linear reconstruction devices (see images of treatment with a monolateral mounter), better tolerated by patients than so-called “circular” fixators, more invasive and bulky devices, poorly tolerated by the user generally.
On a few occasions, its use is essential due to the characteristics of the lesion. We are generally treating patients whose pathology originated years ago, has been around for a long time, and has undergone multiple failed treatments. It is clear that we should not subject patients to any risk, if possible. In all the mentioned pathologies we do not use instrumentation techniques of the bone object of reconstruction to shorten the duration of the treatment.
The association of infection with internal osteosynthesis has been more than demonstrated, the role played by implants in the phenomenon of bacterial adhesion to germs and the negative cellular and humoral effect that the implant produces locally, reducing resistance to infections, depressing effect on the patient's immune system, favoring the appearance of infection. Our obligation to our patients is to do everything possible to minimize the risk of new complications.
There are technical variations that also use distraction osteogenesis, which offer shorter treatment times, basing it on the early removal of the fixation system used, either overlapping the active phase of the reconstruction, internal osteosynthesis devices (generally nails ) or once the active reconstruction phase of transport/lengthening has been completed, performing internal osteosynthesis, either nails or osteosynthesis material, plates and/or intramedullary nails. In the group of pathologies described in this article, mostly associated with initial septic complications, we have only routinely used external fixation in reconstruction.
