3+4+Supplementum/2012 - Společnost pro pojivové tkáně

ORiGinal PaPeR BaSed On CaSe
RePORT
SiliCaTe-CalCiuM-
PHOSPHaTe COnTRiBuTeS
TO THe BOne CORTiCaliS
MOdellinG/ReMOdellinG –
BiOMeCHaniCal aSPeCTS and
CliniCal ReSulTS: a CaSe RePORT
Mařík I 1) , Petrtýl M 3) , Myslivec R 1, 2) , Maříková A 1) ,
Danešová J 3)
1) Ambulant Centre for Defects of Locomotor
Apparatus, Olšanská 7, Prague 3, 130 00,
Czech Republic
2) Czech Technical University, Faculty of Civil
Engineering, Laboratory of Biomechanics and
Biomaterial Engineering, Thakurova 7, Prague 6,
160 00, Czech Republic
3) Othopaedic-Traumatologic Department ON
Příbram a.s., U nemocnice 84, Příbram, 261 01,
Czech Republic
key words: silicate-calcium-phosphate,
Si-CAP, biomaterials, leg lengthening,
healing
introduction
It was proved that SILICATE-CALCIUM-
PHOSPHATE (Si-CAP) contributes to the
acceleration of bone modelling/remodelling
in bone defects.
At present, bio-mechanically severe
uneven leg length is usually indicated to
step by step lengthening by Ilizarov´s method.
One stage lengthening of the femur is
exceptionally indicated when the growth
is finished because of risk to damage sciatic
nerve. During growth, the epiphysiodesis
of the longer leg is indicated by clinical
anthropologist. There is long term very
good experience with abbreviation osteotomies
of the longer femur. But in our patient
348 14 th Prague-Sydney-Lublin
with achondroplasia and short disproportional
stature every surgical shortening of
legs is undesirable. That is why we decided
for one stage lengthening of the femur in
our patient. The surgical procedure was
carried out in 15 years and 4 months of age
when growth was finished.
The aim of our presentation is to
demonstrate and explain the fundamental
conditions that accelerate the healing
of cortical femoral defects during/after
one stage 24 mm lengthening at a girl with
achondroplasia. On the other hand there
is explained a negative influence of lateral
fixation plate on bone healing because of
so-called shielding effect.
a brief case report
Achondroplasia in a Czech girl was
diagnosed by clinical, anthropological and
radiologic examination in the 1 st year of
age and later was confirmed by a molecular
genetic method (the typical FGFR 3 receptor
mutation was proved). She underwent
step by step lengthening procedures of both
legs and both humeri. Lengthening of both
shanks on 83 mm was carried out in one
stage at the age of 8 years by Ilizarov´s rings.
Lengthening of right femur on 110 mm at
the age 9 years and the the left femur on
85 mm at the age of 10 years were made. The
lengthening had to be stopped due to malfunction
of unilateral lengthening device
(Wagner device, medium-length) that
caused temporary lesion of bone remodelling
– healing of bone regenerate lasted
around one year. Lengthening of the right
humerus on 70 mm and the left humerus
on 65 mm was made in the age of 13 years
and 14 years, respectively. In 15 years and
4 months one stage lengthening of the left
femur was carried out. During surgery after