Fracture after distraction osteogenesis

We reviewed 173 patients undergoing distraction osteogenesis to determine t he incidence, location and timing of fractures occurring as a complication of the procedure, There were 17 fractures in 180 lengthened segments giving an overall rate o f fracture of 9.4%. Unexpectedly, the pattern and location of the fractures were very variable; six were within the regenerate itself, six at the junc tion between the regenerate and the original bone and five at distant sites in the limb. Of those occurring in the regenerate, five were noted to be a ssociated with compression and partial collapse of the regenerate. In three patients collapse and deformity developed gradually in the distracted segm ent over the six months after removal of the frame, The method of treatment of these fractures should be chosen to take into ac count multiple factors, which are additional and often different from those to be considered during management of acute traumatic injuries, Internal f ixation appears to be most appropriate for displaced fractures, although in small children, or in those in whom there has been, or is, infection of th e screw tracks, a new period of treatment using external fixation may be ne eded, Fixation by intramedullary nailing was associated with a risk of infe ction, even if screw tracks were assessed as healthy at the time of inserti on of the nail, Internal fixation with the use of plates is safe for displa ced, unstable fractures in children.