Strategies in Trauma and Limb Reconstruction

Register      Login

VOLUME 6 , ISSUE 3 ( November, 2011 ) > List of Articles

CASE REPORT

“Asymmetric scalloping of the regenerate”: a radiological sign of pseudoaneurysm in distraction osteogenesis

J. Fagg, A. Gulihar, J. A. Fernandes

Keywords : Asymmetric scalloping, Regenerate, Pseudoaneurysm, External fixator, Distraction osteogenesis

Citation Information : Fagg J, Gulihar A, Fernandes JA. “Asymmetric scalloping of the regenerate”: a radiological sign of pseudoaneurysm in distraction osteogenesis. 2011; 6 (3):159-162.

DOI: 10.1007/s11751-011-0121-4

License: CC BY-NC-SA 4.0

Published Online: 01-06-2012

Copyright Statement:  Copyright © 2011; The Author(s).


Abstract

Pseudoaneurysm formation is an uncommon but well-recognised and important complication in limb reconstruction surgery. Postoperative diagnosis is usually clinical or an incidental finding. We present an 11-year-old girl, who underwent two-stage limb lengthening with a circular fixator, for a previously treated pseudoarthrosis of the tibia. During the lengthening plan, a concave defect was noted on one side of the regenerate, which was found to be due to extrinsic compression by a pseudoaneurysm. Normal regenerate formation was seen after selective embolisation of the pseudoaneurysm. This concave appearance on one side of the regenerate has previously been described secondary to a difference in stability on the two sides of the osteotomy, when a monolateral fixator is used, but not due to extrinsic compression by a pseudoaneurysm. The authors propose that this radiographic appearance of “asymmetrical scalloping” on one side of the regenerate may represent a radiological sign of a pseudoaneurysm formation and should provoke investigation for the same.


PDF Share
  1. Gellman R, Beaman D (2004) External fixation for distraction osteogenesis. Foot Ankle Clin 9(3):489-528
  2. Maffuli N, Fixsen JA (1996) Distraction osteogenesis in congenital limb length discrepancy: a review. J R Coll Surg Edinb 41(4):258-264
  3. Spiegelberg B, Parratt T, Dheerendra SK, Khan WS, Jennings R, Marsh DR (2010) Ilizarov principles of deformity correction. Ann R Coll Surg Engl 92(2):101-105
  4. Endo H, Asaumi K, Mitani S, Noda T, Minagawa H, Tetsunaga T, Ozaki T (2008) The minimally invasive plate osteosynthesis (MIPO) technique with a locking compression plate for femoral lengthening. Acta Med Okayama 62(5):333-339
  5. Simpson AH, Shalaby H, Keenan G (2009) Femoral lengthening with the Intramedullary Skeletal Kinetic Distractor. J Bone Joint Surg Br 91(7):955-961
  6. Dhal A, Chadha M, Lal H, Singh T, Tyagi S (2001) Encounters with pseudoaneurysms in orthopaedic practice. Injury 32(10):771-778
  7. Paul MA, Patka P, van Heuzen EP, Koomen AR, Rauwerda J (1992) Vascular injury from external fixation: case reports. J Trauma 33(6):917-920
  8. Polak WG, Pawlowski S, Skora J, Morasiewicz L, Janczak D, Oleszkiewicz M, Szyber P (2001) Vascular complications after the treatment with Ilizarov external fixators. Vasa 30(2):138-140
  9. Rickman M, Saleh M, Gaines PA, Eyres K (1999) Vascular complications of osteotomies in limb reconstruction. J Bone Joint Surg Br 81(5):890-892
  10. Zitsman JL (1998) Pseudoaneurysm after penetrating trauma in children and adolescents. J Pediatr Surg 33(10):1574-1577
  11. Burli P, Winterbottom AP, Cousins C, Appleton DS, See TC (2008) Imaging appearances and endovascular management of uncommon pseudoaneurysms. Clin Radiol 63(11):1254-1264
  12. Li R, Saleh M, Yang L, Coulton L (2006) Radiographic classification of osteogenesis during bone distraction. J Orthop Res 24(3):339-347
  13. Donnan LT, Saleh M, Rigby AS, McAndrew A (2002) Radiographic assessment of bone formation in tibia during distraction osteogenesis. J Pediatr Orthop 22(5):645-651
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.