Paley proposed sorting the difficulties of Ilizarov limb lengthening into problems, obstacles and true complications, and applied the scheme to his own lengthening series.
Clinical series of 46 patients aged 2 to 54 with 60 limb segments lengthened by the Ilizarov method, followed 6 months to 2 years.
Methods
Design
Clinical series of Ilizarov lengthening, with or without simultaneous deformity correction
Whether resolving the difficulty needed an operation
Whether it was resolved by the end of treatment
Intraoperative injury
Key Findings
Original treatment goals were reached in 57 of 60 lengthened limb segments.
All 3 segments that missed their goal (1 nonunion, 2 late bowing) were in adults, and in each the loosened frame had been removed prematurely without adequate protection afterward.
More than three‑quarters of true complications and obstacles occurred in the first 20 patients, which the author took as confirming a significant learning curve.
Pin infections were the most frequent problem, accounting for 20 of 35 problems in 13 patients.
Seven true complications were caused directly by intraoperative injury: 3 motor nerve injuries, 3 sensory nerve injuries and 1 hematoma.
The only true nonunion followed simultaneous lengthening through a tibial corticotomy and a tibiotalar arthrodesis, and the author judged lengthening through an arthrodesis site probably best avoided.
Board pearl
In Paley's scheme, a problem and an obstacle differ only by whether an operation was needed to resolve it. A true complication is any intraoperative or perioperative complication, any difficulty unresolved at the end of treatment, or any early or late post‑treatment difficulty such as refracture.
Paley classification of lengthening difficultiesPaley, Clin Orthop Relat Res 1990
Problem
Expected difficulty during distraction or fixation, resolved without an operation
Managed in clinic. 35 in this series.
Obstacle
Expected difficulty during distraction or fixation, resolved by an operation
11 in this series, including incomplete corticotomies and incorrect constructs.
True complication
Any intraoperative or perioperative complication, any difficulty unresolved at the end of treatment, or any early or late post‑treatment difficulty
Minor
Of little significance (17 in this series)
Major
9 in this series, 3 of which prevented the original goal
Authors' conclusion
Despite these problems, obstacles, and complications, the original goals of surgery were achieved in 57 of the 60 limb segments treated. Patient satisfaction was achieved in 94% of 46 cases.
Paley proposed sorting the difficulties of Ilizarov limb lengthening into problems, obstacles and true complications, and applied the scheme to his own lengthening series.
Clinical series of 46 patients aged 2 to 54 with 60 limb segments lengthened by the Ilizarov method, followed 6 months to 2 years.
Methods
Design
Clinical series of Ilizarov lengthening, with or without simultaneous deformity correction
Whether resolving the difficulty needed an operation
Whether it was resolved by the end of treatment
Intraoperative injury
Key Findings
Original treatment goals were reached in 57 of 60 lengthened limb segments.
All 3 segments that missed their goal (1 nonunion, 2 late bowing) were in adults, and in each the loosened frame had been removed prematurely without adequate protection afterward.
More than three‑quarters of true complications and obstacles occurred in the first 20 patients, which the author took as confirming a significant learning curve.
Pin infections were the most frequent problem, accounting for 20 of 35 problems in 13 patients.
Seven true complications were caused directly by intraoperative injury: 3 motor nerve injuries, 3 sensory nerve injuries and 1 hematoma.
The only true nonunion followed simultaneous lengthening through a tibial corticotomy and a tibiotalar arthrodesis, and the author judged lengthening through an arthrodesis site probably best avoided.
Board pearl
In Paley's scheme, a problem and an obstacle differ only by whether an operation was needed to resolve it. A true complication is any intraoperative or perioperative complication, any difficulty unresolved at the end of treatment, or any early or late post‑treatment difficulty such as refracture.
Paley classification of lengthening difficultiesPaley, Clin Orthop Relat Res 1990
Problem
Expected difficulty during distraction or fixation, resolved without an operation
Managed in clinic. 35 in this series.
Obstacle
Expected difficulty during distraction or fixation, resolved by an operation
11 in this series, including incomplete corticotomies and incorrect constructs.
True complication
Any intraoperative or perioperative complication, any difficulty unresolved at the end of treatment, or any early or late post‑treatment difficulty
Minor
Of little significance (17 in this series)
Major
9 in this series, 3 of which prevented the original goal
Authors' conclusion
Despite these problems, obstacles, and complications, the original goals of surgery were achieved in 57 of the 60 limb segments treated. Patient satisfaction was achieved in 94% of 46 cases.