A Fully Implantable Motorized Intramedullary Nail for Limb Lengthening and Bone Transport

Baumgart, R; Betz, A.; Schweiberer, L.

doi:10.1097/00003086-199710000-00023

Cited by 198 publications

(182 citation statements)

References 6 publications

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“…2 cm to max. 17.4 cm) for Ilizarov ring fixators (IRF) [48,57,58] and intramedullary nails [16,46,50,[59][60][61][62][63][64] and around 2.5-3 cm (min. 8 mm to max.…”

Section: Indications For Leg Lengtheningmentioning

confidence: 99%

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Current concepts of leg lengthening

Hasler

Krieg

2012

Journal of Children's Orthopaedics

101

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Any lower limb discrepancy may be equalised by conservative means (insoles, prosthesis and orthosis). However, their long-term acceptance is low in regard to function, costs, expenditure and appearance. Timely epiphysiodesis is the best option in uniplanar deformities with adequate remaining growth and for patients whose predicted final body height is above the 50th percentile. However, many patients present late or with multi-planar deformities, which warrant more sophisticated operative approaches. The history of surgical bone lengthening comprises 100 exciting years of struggling, development and ongoing learning. The initial strategy of acute or rapid incremental distraction had lasted almost half a century until Ilizarov recognised the benefits of biological periosteum-preserving osteotomies and incremental lengthening at slow rates (1 mm/day) at a 4 × 0.25-mm daily rhythm, well appreciated as callotasis. In parallel, ring and wire constructs made complex three-dimensional axial, translational and rotational bone moulding possible. Taylor Spatial Frames—built on hexapod strut-linked platform technology as known from flight simulators—took limb correction to a more reliable, more precise and aesthetical level, all the more that the whole process became web-based. It represents state-of-the-art methodology and technology for complex, multi-plane deformities. Due to the significant risk of secondary malalignment, indications for lengthening by unilateral fixation have shrunken to moderate amounts of length disparity and uni- to bi-planar deformities in patients with still open physes. Mechanical or motorised, minimally invasively placed nails prevent muscle fixation and, therefore, ease rehabilitation, increase patient comfort and potentially shorten the overall time of sick leave and refrain from sports activities. Hence, they offer a valuable alternative for low-grade complexity situations. It remains to be proved if the significantly higher implant costs are compensated by lower treatment costs. Overall, limb lengthening, particularly in combination with multi-planar deformity correction, can still be an arduous endeavour. In any case, wise judgement of the patient’s deformity, medical and biological situation, psychosocial environment, selection of the appropriate method and hardware, as well as meticulous operating technique by an experienced surgeon are the cornerstones of successful outcomes.

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“…2 cm to max. 17.4 cm) for Ilizarov ring fixators (IRF) [48,57,58] and intramedullary nails [16,46,50,[59][60][61][62][63][64] and around 2.5-3 cm (min. 8 mm to max.…”

Section: Indications For Leg Lengtheningmentioning

confidence: 99%

“…Preservation of periosteum as the main source of blood supply is critical [46,[75][76][77][78][79][80][81]. Its disruption significantly decelerates bone formation [75,82].…”

Section: Osteotomy Techniques and Biology Of Callotasismentioning

confidence: 99%

Current concepts of leg lengthening

Hasler

Krieg

2012

Journal of Children's Orthopaedics

101

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“…Therefore, we performed corticotomy at the meta-diaphyseal junction, and the problem was resolved by placing a half pin when applying the external fixator. In the tibia, where mechanical and anatomical axes coincide, lengthening over an intramedullary nail is indicated, as opposed to the femur, where the two axes are different and would cause additional translation [2,14]. The limitation of this study was that the intramedullary nail could not be used for cases of severe deformity combined with shortening.…”

Section: Discussionmentioning

confidence: 98%

Tibial lengthening using a reamed type intramedullary nail and an Ilizarov external fixator

Kim

Lee

Kim

et al. 2008

International Orthopaedics (SICOT)

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The aim of this study was to evaluate the efficacy of tibial lengthening using a reamed type intramedullary nail and an Ilizarov external fixator for the treatment of leg length discrepancy or short stature. This retrospective study was performed on 18 tibiae (13 patients) in which attempts were made to reduce complications. We used an Ilizarov external fixator and a nail (10 mm diameter in 17 tibiae and 11 mm in one tibia) in combination. Average limb lengthening was 4.19 cm (range, 2.5-5.5). The mean duration of external fixation was 12.58 days per centimetre gain in length, and the mean consolidation index was 40.53 (range, 35.45-51.85). All distracted segments healed spontaneously without refracture or malalignment. Gradual limb lengthening using a reamed type intramedullary nail and circular external fixation in combination was found to be reliable and effective and reduced external fixation time with fewer complications.

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“…Few data have been published concerning the FITBONE 1 TAA for intramedullary leg lengthening [4,6,37]. The concept that led to the development of techniques using intramedullary nails for callus distraction was to achieve leg lengthening with faster rehabilitation and a lower rate of complications [3,9,19]. We explored whether functionality and outcome support these concepts.…”

Section: Discussionmentioning

confidence: 99%

“…Betz et al [7] developed the first fully implantable, motorized lengthening device with a subcutaneous receiver. In 1997, Baumgart et al reported successful implantation and outcomes with no major complications in 12 adult patients for limb lengthening and bone transport [3]. Nonetheless, results in the literature are limited and require confirmation.…”

Section: Introductionmentioning

confidence: 99%

Leg Lengthening With a Motorized Nail in Adolescents

Krieg

Speth

Foster

2008

Clinical Orthopaedics &Amp; Related Research

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Leg lengthening by external fixation is associated with various difficulties. We evaluated eight adolescent patients who underwent leg lengthening with a motorized intramedullary lengthening device. We asked whether this method could reduce the time of hospitalization and rehabilitation and whether the incidence of complications commonly associated with external fixators could be reduced. We compared our preliminary results with those from other reports, with a focus on leg length achieved, time of rehabilitation, and rate of complications. The average leg-length discrepancy was 3.8 cm (range, 3-5 cm). The average lengthening distance was 3.8 cm (range, 2.9-4.7 cm). In six patients, leg lengthening was combined with successful correction of the mechanical axis alignment. The consolidation index averaged 26 days/cm (range, 19-41 days/cm). The average hospital stay was 9.6 days. No bone or soft tissue infections were observed. In comparison to other studies (1.0-2.8 complications/ patient), our results suggest that the difficulties commonly associated with external fixators can be reduced with this method. It also allows good angular correction in patients with mechanical axis deviation. These features combined with a short time of hospitalization and rehabilitation make it a promising procedure for limb lengthening.

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A Fully Implantable Motorized Intramedullary Nail for Limb Lengthening and Bone Transport

Cited by 198 publications

References 6 publications

Current concepts of leg lengthening

Current concepts of leg lengthening

Tibial lengthening using a reamed type intramedullary nail and an Ilizarov external fixator

Leg Lengthening With a Motorized Nail in Adolescents

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