Upper Metaphyseal Lengthening of the Tibia by Callotasis

We report a series of 47 upper metaphyseal lengthenings of the tibia by callotasis in 40 children and adolescents. Fifteen cases were treated with a Judet T distractor; the remaining 32 were treated with a device designed by the authors (Orthofix) which permits axial correction in the frontal plane for better control of the valgus deviation. Results are compared with those of other studies, with particular reference to series of lengthenings by the Ilizanov method. Complications occurred in 29 of the 47 lengthenings. Of these, 11 were benign, 17 required treatment not included in the original protocol, and one gave rise to sequelae. Consolidation was rapid, with only one fracture and one nonunion. We stress the excellent control of valgus obtained with this lengthener, obviating the need for tibial realignment by further operation. We emphasize the importance of appropriate dynamization of the callus, with controlled micromovements provided by a silastic collar (Dyna-Ring) resulting in an average decrease in healing time of 28%. The technique for its use is explained in detail.