Analysis of callus pattern of tibia lengthening in achondroplasia and a novel method of regeneration assessment using pixel values

Suryaudai Singh, Hae Ryong Song, K. P. Venkatesh, Hitesh N. Modi, Man Sik Park, Ki Mo Jang, Seung J. Kim

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)


Objective: To relate morphology of new bone formation to outcome after tibial lengthening performed in patients with achondroplasia. Material and methods: A retrospective analysis of 60 tibial segments in 30 achondroplasia patients was performed. There were 22 female patients and eight male patients, with a mean age of 9.8 years. New bone formation was classified by shape, homogeneity and density. Pixel values in relation to original bone were measured using a picture-archiving communication system (PACS). Clinical outcome was described by the external fixator and maturation indices. Results: Mean lengthening was 9.2 cm (range 3-12.7 cm). The mean external fixator index was 23.4 (range 15.1-50). The mean maturation index was 12.3 days/cm (range 6-40 days/cm). Homogeneous pathways were associated with the best clinical results (fixator index 20.4, maturation index 10.8), followed by heterogeneous pathway (external fixator index 26.5, maturation index 16.8) and radiolucent pathway (fixator index 31.2, maturation index 21.4). Both cylindrical (external fixator index 25.2, maturation index 14.5) and concave (external fixator index 26.6, maturation index 16.3) callus shapes were favourable. Mineralization of new bone became equal to that of normal bone within 16 weeks (mean) for homogeneous pathway, 12 weeks for heterogeneous pathway and 32 weeks for lucent pathway. Conclusion: The type of new bone formation seen on radiographs is related to clinical outcome, with homogeneous pathways being the most favourable ones.

Original languageEnglish
Pages (from-to)261-266
Number of pages6
JournalSkeletal Radiology
Issue number3
Publication statusPublished - 2010 Mar

Bibliographical note

Funding Information:
Acknowledgement This study was supported by a grant from the Korea Healthcare Technology R&D Project, Ministry for Health, Welfare and Family Affairs, Republic of Korea (A080588).


  • Achondroplasia
  • Bone regeneration
  • Callus pattern
  • Distraction osteogenesis
  • Ilizarov external fixator
  • Pixel value
  • Tibia lengthening

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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