Radiographic and ultrasound evaluation of distraction regenerate's formation in limbs elongation

Congress:

ECR 2018

Poster Number:

C-0203

Type:

Scientific Exhibit

Keywords:

Musculoskeletal bone, Paediatric, Conventional radiography, Ultrasound, Radiation safety, Dysplasias

Authors:

N. Lysenko, O. Sharmazanova, I. Voronzhev; Kharkov/UA

DOI:

10.1594/ecr2018/C-0203

DOI-Link:

https://dx.doi.org/10.1594/ecr2018/C-0203

Fig. 4: Plain radiographs of a 6-year-old female patient, congenital anomaly of a lower...

Fig. 5: Ultrasound image of the distraction site, the same patient, the 10th day of...

Fig. 6: Plain radiograph of an 11-year-old male patient, achondroplasia; bifocal...

Fig. 7: The same patient, ultrasound image of the distraction site, the 45th of...

Fig. 8: Plain radiograph of the same patient, 1.5 months of fixation period, mature...

Fig. 9: Ultrasound image of the same patient, 1.5 months of fixation period

Table 1: Frequency and periods of the new bone visualized

Table 2: Duration of distraction and fixation periods, and terms of regenerate formation.

Results

Signs of the distraction regenerate formation became visible in 10 days of distraction. We saw a few cloud-like low intensity shadows in 35 (54.7%) patients on plain radiographs (fig. 4), while ultrasound images showed visible hyper-echogenic structures in 60 (93.8%, p≤0.01) patients (fig. 5).

At the end of the distraction period (in 40-45 days), high intensity linear shadows and ‘growth-zone’ in the new bone center were determined on X-ray films in all patients (fig. 6). Ultrasound image showed 1.5 cm and 2 cm cysts within the distraction regenerate which were not visible on radiographs (fig. 7). During the fixation, radiography was the only method we used to determine structure and features of osteogenesis (fig. 8). The new formed bone cortex was a barrier for ultrasound visualization in this period (fig. 9).

Table 1 demonstrates frequency of new bone signs shown on plain radiographs and ultrasound images in the different periods of treatment.

Table 2 shows the average terms of regenerate formation in two groups of patients. Tendency to earlier maturation of bone regenerate in younger children, compared with those older, was registered.

Specific features of the lower limb regenerate growth were revealed. We saw the basic mass of a new bone on the side opposite the rod apparatus during the early distraction period in 82.0% patients. Further, when the cortical layer has formed, distraction regenerate became symmetric, spacing all bone diameter.