The effect of distraction callus quality on final outcomes following tibial and femoral distraction osteogenesis using a monorail fixator
Asep Santoso, Paramasari Dirgahayu, Ratih D. Yudhani, Brian Wasita, Ida Nurwati, Pamudji UtomoObjectives:
The quality of callus formation is an important factor in the success of distraction osteogenesis (DO), particularly in tibial and femoral lengthening procedures using monorail external fixators. However, its direct impact on clinical outcomes remains underreported. The aim of this study was to evaluate the association between radiographically classified distraction callus quality and final outcomes in patients undergoing tibial or femoral DO using a monorail external fixator.
Methods:
This retrospective study reviewed 110 patients who underwent tibial or femoral DO between December 2018 and July 2023. Callus morphology was assessed using the modified Hamanishi classification and categorized into two groups: Good to excellent (Group A) and fair to poor (Group B). Final outcomes, including union rates and complication profiles, were compared between the two groups.
Results:
Of the 110 patients, 86 (78.2%) demonstrated good to excellent callus formation, while 24 (21.8%) exhibited fair to poor morphology. Group A demonstrated significantly higher union rates (94.2% versus 66.7%) and a lower prevalence of distraction site non-union (0% versus 25%; p = 0.001). The prevalence of complications such as ankle stiffness (8.1% versus 12.5%), infection (0% versus 4.2%), and fixation failure (1.2% versus 4.2%) did not differ significantly between groups ( p = 0.495).
Conclusion:
Radiographic assessment of regenerate callus quality can be proposed as a valuable predictive factor for final outcomes and treatment success in tibial and femoral bone DO. Further study with multivariate regression analysis is needed to confirm this finding.