Comparison between lengthening over nail and conventional Ilizarov lengthening: a prospective randomized clinical study

Objective:To evaluate the outcomes of lengthening post-traumatic femoral segments using a recently available magnetic intramedullary (IM) lengthening system.Design:Retrospective cohort study.Setting:Urban level II Trauma Center.Patients/Participants:Patients treated for post-traumatic femoral shortening at our institution between 2012 and 2015. We identified 17 femurs lengthened (14 men and 3 women). The mean age was 30 years (range, 11–72 years).Intervention:Magnetic IM lengthening system.Main Outcome Measurements:Amount of lengthening achieved, consolidation index, and complications encountered.Results:The mean follow-up was 2.2 years (range, 1–3.7 years). Sixteen patients achieved the planned lengthening, a mean of 3.8 cm (range, 2.3–6.0 cm). Regenerate consolidation occurred at a mean of 119 days (range, 57–209 days). The mean consolidation index was 32 d/cm (range, 16–51 d/cm). Three patients (18%) experienced complications.Conclusion:IM lengthening nails are an improvement over external fixators for treatment of post-traumatic femoral shortening. Within certain limits, their use can be extended to problems of limb-length discrepancy with angular/rotational deformity.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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“…9 However, serious complications such as deep infections, refractures, and axial deviation were still observed. 10–12 …”

Section: Introductionmentioning

confidence: 99%

Treatment of Post-Traumatic Femoral Discrepancy With PRECICE Magnetic-Powered Intramedullary Lengthening Nails

Hammouda

Jauregui

Gesheff

et al. 2017

Journal of Orthopaedic Trauma

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“…However, the major criticism of this technique is the elevated risk of infection, due to the presence of external fixator fiches that may transmit superficial infection along the intramedullary nail. To minimize this possible complication, some authors recommend avoiding any contact between the fiches and nail [13, 14]. We think that avoiding any contact between the fiches and nail is very challenging, although in some cases it can be achieved.…”

Section: Discussionmentioning

confidence: 99%

Lower limb lengthening over an intramedullary nail: a long-term follow-up study of 28 cases

et al. 2019

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Background Limb lengthening using an external fixator requires a long period of external fixation and may be associated with several complications such as axial deformity, fracture of the regenerated bone, and joint stiffness. With the goal of reducing the time of external fixation as well as some of these complications, we performed femoral or tibial lengthening over an intramedullary nail, according to Paley’s technique, in 28 patients, followed up after a mean period of 8 years. Materials and methods Twenty-eight patients treated for lower limb discrepancy by limb lengthening over an intramedullary nail were reviewed from 5 to 11 years after healing of regenerated bone. There were 20 femurs and 8 tibiae, with average age at surgery of 14.2 years and average length inequality of 6.1 cm for femurs and 5.3 cm for tibiae. Results The mean lengthening was 5.8 cm for femurs and 4.8 cm for tibiae. The mean period of radiographic consolidation of the regenerated bone was 6 months for femoral lengthening and 4.5 months for tibial lengthening. At follow-up, we observed 8 excellent results, 15 good results, 4 fair results, and 1 poor result, based on Paley’s evaluation criteria. The main complications were one deep infection, one nonunion of the distracted segment, one breakage of the distal fiche of the external fixator, and one breakage of both distal locking screws of the intramedullary nail. Discussion We believe that limb lengthening over an intramedullary nail still represents a good method to treat limb length discrepancy because it reduces the time of external fixation, prevents axial deformities and fractures of regenerated bone, and allows early rehabilitation. The new intramedullary lengthening nails, which theoretically are the ideal device for treating limb length inequality, are still very expensive and need longer follow-up for definitive evaluation. Level of evidence 4.

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“…However, the concomitant use of an intramedullary nail, such as with tibial LON, can act as a strong resistance to the deforming forces, minimizing axial deviations compared with the classic Ilizarov method. Some studies [2,3,15,20,21] compared the classic Ilizarov method with the LON technique and showed that axial deviation occurred in 4% to 13% of tibias with the classic Ilizarov method, whereas it was 0% to 2% with the LON technique. However, Kim et al [8] reported that they observed 20 segments (14%) that showed valgus angulation with a mean of 10°using the LON technique.…”

Section: Discussionmentioning

confidence: 99%

Is there an Increase in Valgus Deviation in Tibial Distraction Using the Lengthening Over Nail Technique?

Park

Ryu

Kim

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background During tibial lengthening, the soft tissues of the posterolateral compartment produce distraction-resisting forces causing valgus angulation. Although this occurs with the classic Ilizarov method, whether a valgus deformity develops with the lengthening over nail (LON) technique is questioned, because the intramedullary nail is thought to resist deforming forces and adequately maintain alignment of the distracted bone. Questions/purposes The purposes of this study were to (1) determine the amount of valgus deviation during tibial lengthening with the LON technique; and (2) analyze the factors that may be associated with valgus deviation with the LON technique. Methods Between June 2009 and September 2013, we performed 346 tibial lengthenings using the LON technique, lengthening and then nail technique, or lengthening with an intramedullary lengthening device. Sixty patients (120 tibias) who underwent bilateral lower leg lengthening with the LON technique were enrolled in this retrospective study. To limit the number of variables, we analyzed only the right tibia in all patients (60 tibias). The mean followup was 42 months (range, 26-71 months). The mean age of the patients was 25 years (range, 18-40 years). There were 36 male and 24 female patients. The mean final length gain was 67 ± 9 mm. The mean time for distraction was 100 ± 25 days. The overall valgus deviation was assessed by measuring the change in the medial proximal tibial angle and mechanical femorotibial angle on radiographs obtained before and after surgery and after completion of lengthening. Several demographic, surgical, and distraction-related variables were considered possible factors to prevent valgus deviation: proximal fixation method; presence of a blocking screw; diameter and length of the intramedullary nail; degree of nail insertion; length of the nail in the distal segment after completion of distraction; final length gain; and patient's BMI. During the period studied, the blocking screw was to maintain the mechanical axis in patients who had neutral or valgus alignment preoperatively, or to prevent more valgus change in patients who underwent acute correction of varus deformity intraoperatively. Uni-and multivariate analyses were conducted. Results Valgus deviation occurred during the tibial LON. The medial proximal tibial angle increased from 86°(95% CI, 85°-86°) to 90°(95% CI, 89°-91°) (p \ 0.001). The mechanical femorotibial angle changed from 2.2°varus (95% CI, 3°-1.4°varus) to 2.6°valgus (95% CI, 1.8°-3.4°E

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Comparison between lengthening over nail and conventional Ilizarov lengthening: a prospective randomized clinical study

Cited by 29 publications

References 15 publications

Treatment of Post-Traumatic Femoral Discrepancy With PRECICE Magnetic-Powered Intramedullary Lengthening Nails

Treatment of Post-Traumatic Femoral Discrepancy With PRECICE Magnetic-Powered Intramedullary Lengthening Nails

Lower limb lengthening over an intramedullary nail: a long-term follow-up study of 28 cases

Is there an Increase in Valgus Deviation in Tibial Distraction Using the Lengthening Over Nail Technique?

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