الفهرس 
Tensile properties of the physisOnly 14 pages are availabe for public view
 |  | from | 87 |  |  |
| | | from | 87 | | |
Abstract
Epiphyseal distraction is a relatively new technique of lengthening. It is divided into two main types; chondrodiatasis and distraction epiphysiolysis. Chondrodiatasis which was first described by De Bastiani is the slow, controlled and symmetrical distraction of the epiphyseal plate which does not involve fracturing of the epiphyseal plate. Many authors though, have argued that significant lengthening cannot be achieved without fracturing the plate.
On the other hand Zazijalov and Plaskin were the ones who first introduced the term distraction epiphysiolysis but Monticelli and spinelli were the first to describe it in humans. It entails fracturing of the plate. This is done by several ways;
• Closed distraction with secondary detachment epiphysiolysis.
• Closed distraction with primary epiphysiolysis utilizing the distraction device itself.
• Distraction physioclasis, which is primary epiphysiolysis with the surgeon’s hands.
The last two have the advantage of avoiding the pain associated with the secondary separation of the epiphysis and also to avoid the bow and arrow effect on the soft tissues.
The procedure involves:
• Application of the distraction device
• Distraction period; usually at a rate of 1mm per day. It is about 55% of the treatment period.
• Neutralization period; usually about 20% of the treatment time. During this time, any deviations can be corrected by manipulating the frame of the device.
• Dynamic axial loading period; about 25% of the treatment time. During this, the regenerate consolidates as dynamic compression seems to stimulate cortical bone formation.
• Removal of the device
It is advised to use the Ilizarov apparatus to make use of the many advantages of this versatile circular frame and avoid complications such as axial deformity in the regenerate bone. With the Ilizarov apparatus it is also possible to allow full weight bearing immediately post operative.
The complications that occur are typical of those that occur with all shaft lengthening methods. On the other hand, it leaves minimal scars, is less traumatic to the soft tissues, there is no need for an osteotomy, there is no risk of infection of the lengthened segment and there has been no cases of non-union reported.
The results obtained such as the amount of lengthening and the healing index are comparable to other lengthening techniques.
The only major drawback is that there is no guarantee about the behaviour of the physis after distraction. It can be postulated that the growth affection after distraction is due to the inherent growth rate of the affected growth plate itself.(3) The most recent study available though, states that with an average follow up period of 9.6 years, all the tibial and femoral epiphyseal plates started to function in all patients and that premature growth cartilage fusion was not observed.(2)