Complications and outcome of tibial lengthening using the Ilizarov method with or without a supplementary intramedullary nail

Abstract

We compared the complications and outcome of tibial lengthening using the Ilizarov method with and without the use of a supplementary intramedullary nail. In a retrospective case-matched series assembled from 176 patients with tibial lengthening, we matched 52 patients (26 pairs, group A with nail and group B without) according to the following criteria in order of importance: 1) difference in amount of lengthening (± 2 cm); 2) percentage difference in lengthening (± 5%); 3) difference in patient's age (± seven years); 4) aetiology of the shortening, and 5) level of difficulty in obtaining the correction. The outcome was evaluated using the external fixator index, the healing index and an outcome score according to the criteria of Paley. It was found that some complications were specific to group A or B respectively, but others were common to both groups. The outcome was generally better in lengthenings with a nail, although there was a higher incidence of rectifiable equinus deformity in these patients.

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

“…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.…”

“…It can act as a guide such that the bone is lengthened along the longitudinal axis of the nail with no axial deviations. It was reported that the secondary deformity induced during distraction could be substantively negated with the intramedullary nail in the LON technique of the tibia [3,15,20,21]. However, Kim et al [8] reported that a valgus deviation was the most common complication in 20 segments (25%) in their series of the LON technique of the tibia.…”

“…Another potential advantage of this technique is that it prevents the secondary deformity that can occur during distraction [3,15,20,21]. In contrast to the classic Ilizarov method, the intramedullary nail in the LON technique is thought to resist distraction-resisting deforming forces [14,20].…”

“…In contrast to the classic Ilizarov method, the intramedullary nail in the LON technique is thought to resist distraction-resisting deforming forces [14,20]. It can act as a guide such that the bone is lengthened along the longitudinal axis of the nail with no axial deviations.…”

Functional Recovery after Operative Lower Limb Lengthening at High-Division Regime in Children

“…От этого зависит качество и продолжительность лечения, сроки которого не всегда удовлетворяют врачей и самих пациентов. Общий срок лечения па-циентов в зависимости от величины удлинения варьирует от 4 до 18 месяцев [4,5]. Количество возникших трудностей в периоде лечения и ре-абилитации напрямую отражает качество жизни пациентов [6].…”