Application of locked intramedullary nails in the treatment of complications after distraction osteogenesis

Abstract

istraction osteogenesis (callotasis) has been widely used in patients with limb-length inequality or massive bone defects. This procedure, however, may be associated with a high incidence of physical and psychosocial complications. Callotasis telescoping on a locked intramedullary nail has been used to shorten the period of external fixation. Little attention has been given to the use of locked intramedullary nails in the treatment of complications after callotasis.Between 1990 and 1999, we used locked intramedullary nailing in 27 patients for the treatment of complications after distraction osteogenesis. There were 17 men and ten women with a mean age of 33.2 years (16 to 66). The nail was inserted at a mean of 3.4 weeks (0 to 15) after removal of the external fixator. Simultaneous autogenous bone grafting and soft-tissue reconstruction were also undertaken in seven and two patients, respectively.There was consolidation of the callus or docking site in all patients at a mean of 6.4 months (2 to 14) after surgery. The mean shortening of the callus was 0.7 cm (0 to 2.5). Two patients had infection at the site of a distal screw which resolved after removal of the nail. In 17 patients the nail was removed at a mean of 26 months after its insertion.Locked intramedullary nails are useful in treating complications after distraction osteogenesis in skeletally mature patients. The risk of infection should be borne in mind. Distraction osteogenesis (callotasis) has been widely used in the treatment of patients with leg-length discrepancy or a D massive bone defect.1 There is, however, a high incidence of complications including pin-track infection, fracture of the callus, nonunion of the docking site and delayed formation of callus. There may also be psychosocial complications and poor tolerance by the patient may result in failure or early termination of the procedure.2 Plaster casts or further periods of external fixation and plating have been used in the treatment of fracture or bowing of the callus and premature removal of the external fixator.2,3 Locked intramedullary nails, which have rotatory stability and maintain the length of long bones, have been widely used in the treatment of comminuted fractures. The technique of distraction osteogenesis over an intramedullary nail has also been described. [4][5][6][7] This procedure shortens the period of external fixation and allows an improved range of movement of the adjacent joints. Interlocking nailing after external fixation has also been described for the treatment of compound fractures of long bones. [8][9][10][11][12][13][14] Its use in the treatment of complications after distraction osteogenesis has, however, received little attention. Our aim was to evaluate the results of using locked intramedullary nailing in the treatment of complications after this procedure. Patients and MethodsBetween 1990 and 1999 we undertook 256 procedures for distraction osteogenesis in 223 skeletally mature patients. A total of 26 (10.2%) required internal fixation for complications ...

Limb Lengthening and Then Insertion of an Intramedullary Nail: A Case-matched Comparison

“…Lai et al [19] reported the use of locked intramedullary nails in the treatment of complications after distraction osteogenesis including nonunion at lengthening and docking sites. They achieved 100% bony union in 27 patients and had a deep infection rate of 7%.…”

Staged Protocol for the Treatment of Chronic Tibial Shaft Osteomyelitis With Ilizarov’s Technique Followed by the Application of Intramedullary Locked Nail

“…25,26 However, early removal of the external fixator and replacement by intramedullary nail achieved the same clinical and functional outcome as the classic technique with a shorter duration of external fixation. [27][28][29] Furthermore, the suggested adequate time to perform nailing was when callus formation was radiographically visible at the distraction site because the intramedullary implant could occupy the healing space for osteogenesis.…”

Secondary Intramedullary Nailing for the Treatment of Complications after Bone Lengthening

“…Under these circumstances, in those cases where an additional stabilisation of the lengthening callus or an enhancement of the biological environment for callus growth or union at the docking side was considered necessary, we convert our technique to intramedullary nailing [13,17,19]. The functional, emotional and psychological status of our patients was improved immediately after fixator removal, especially in those cases with prolonged time of application (up to 2 years).…”