Comparison of Intramedullary Magnetic Nail, Monolateral External Distractor, and Spatial External Fixator in Femur Lengthening in Adolescents with Congenital Diseases

Abstract

The aim of this study is to evaluate the course of the treatment and clinical and functional outcomes of femur lengthening in adolescents with congenital disorders by the application of different surgical methods. This retrospective study comprised 35 patients (39 procedures). A total of 11 patients underwent femur lengthening with the use of the intramedullary magnetic nail (IMN) Precise 2 (NuVasive, San Diego, CA, USA), 7 patients (11 procedures) with the use of the monolateral external distractor Modular Rail System (MRS) (Smith and Nephew, Memphis, TN, USA), and 17 with the use of the computer-assisted external fixator Taylor Spatial Frame (TSF) (Smith and Nephew, Memphis, TN, USA). The inclusion criteria were as follows: (1) congenital femoral length deficiency without any axial deformities and (2), independently of the finally applied treatment, the technical possibility of use of each of the analyzed methods. The distraction index did not differ significantly between the groups (p = 0.89). The median lengthening index was the lowest in the IMN group (24.3 d/cm; IQR 21.8–33.1) and statistically different in comparison to the MRS (44.2 d/cm; IQR 42–50.9; p < 0.001) and the TSF groups (48.4 d/cm; IQR 38.6–63.5; p < 0.001). Similarly, the consolidation index in the IMN group (12.9 d/cm; IQR 10.7–21.3) was statistically lower than that in the MRS (32.9 d/cm; IQR 30.2–37.6; p < 0.001) and the TSF (36.9 d/cm; IQR 26.6–51.5; p < 0.001) groups. This study indicates that IMN is a more valuable method of treatment for femoral length discrepancy without axial deformity than MRS and TSF in complication rate and indexes of lengthening and consolidation.

Corrective Osteotomies in Severe Non-Idiopathic Lower Limb Alignment Disorders in the Aspect of Future Joint Endoprosthesis—A Perspective Study

“…In IM fixation, the contact surface in the osteotomy line increases, which provides a shorter healing time compared to other methods [21]. Pietrzak et al demonstrated that IM nailing is the best option for femoral length disorder compared to a monoliteral external distractor and external fixator [22]. Antegrade IM femoral nailing with distal hemiepiphysiodesis is a very promising therapeutic option when young patients require correction of deformity and limb lengthening [23].…”

Does The Lengthening Frequency Affect The Outcome of Distraction Osteogenesis? Comparing Two Times a Day with Four Times a Day Lengthening Protocol

“…However, many studies show that the actual distraction rate achieved is less than that and ranges from 0.5 -0.8 mm/day. [26][27][28][29] Balci et al found that the lengthening speed of 0.56 mm/day is optimal for lengthening in congenital tibial dysplasia. 30 We also reported a mean distraction rate of 0.73 mm/day and found that a distraction rate < 0.7 mm/ day results in almost statistically strong odds of achieving good HI.…”

What’s new in pediatric lower limb reconstruction?

“… 25 In a retrospective comparative study of 75 children from 10 to 18 years of age undergoing lengthening in femurs without axial deformity, fewer adverse events were observed with internal lengthening nails than external fixation. 27 In 50 children between 11 and 17 years of age, femoral lengthenings were compared between external fixation and motorized nails. 28 Patients were matched for age and indication for lengthening, and more complications were found with external fixation.…”