Femoral Lengthening Over a Pediatric Femoral Nail

Gordon, Joel; Manske, M. Claire; Lewis, Thomas R.; O’Donnell, June C.; Schoenecker, Perry L.; Keeler, Kathryn A.

doi:10.1097/bpo.0b013e3182a122a1

Cited by 33 publications

(14 citation statements)

References 21 publications

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“…Infection was one of the main worries when dealing with implant insertion following external fixation with a report of 10.8% of deep infection, including late osteomyelitis after a consolidation period had been completed 11 . The use of the locking plate during external fixator application and the insertion of the retaining screws on the plate during the removal of the external fixator with completion of distraction was not associated with the deep soft tissue infection and osteomyelitis 12 .…”

Section: Discussionmentioning

confidence: 99%

Submuscular Plate Stabilisation After Lengthening: Standard and Modified Techniques

Munajat¹,

Sulaiman²,

Mohd³

et al. 2020

Malays Orthop J

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Introduction: Submuscular plating after lengthening shortened the period of external fixation in distraction osteogenesis of the femur. In the femur, where monolateral or ring fixators had been used for the distraction, plates, could be inserted laterally, anteriorly or medially. Specific technical modification of the plate insertion, however, would be necessary to accommodate the femoral varus angular correction created at the end of the distraction, in the pelvic support osteotomy lengthening. Material and Methods: We reviewed a series of eight cases with standard and modified techniques of plating after lengthening. The amount of lengthening, the period of distraction, the external fixator index and the associated complications were assessed. Results: The mean lengthening was 5cm, with a range of 3cm to 9cm. The external fixation index, the period of external fixators in days in relation to the length of distraction in cm, was between 18 days/cm to 58 days/cm. One patient with quadriceps contracture, underwent quadriceplasty to improve knee flexion. Three patients with transient knee stiffness had resolution with aggressive physiotherapy. One patient with transient hypoesthesia recovered spontaneously. None of the patients developed joint subluxation, deep infection, re-fracture or implant failures. Conclusion: Standard and modified techniques of plating after lengthening were safe and required only a short period of external fixation. The modified technique offered an easier way of plate insertion in a deformed bone.

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Section: Discussionmentioning

confidence: 99%

Submuscular Plate Stabilisation After Lengthening: Standard and Modified Techniques

Munajat¹,

Sulaiman²,

Mohd³

et al. 2020

Malays Orthop J

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“…Most current limb lengthening techniques employ cumbersome devices and are fraught with high rates of complications. Intramedullary nail lengthening techniques with or without external fixator support have been shown to increase patient comfort relative to traditional all-external limb lengthening techniques [ 4 , 10 , 13 , 15 , 17 , 23 – 25 ]. Currently available devices using these techniques include the Albizzia nail, the ISKD® (Intramedullary Skeletal Kinetic Distractor) system (Orthofix Holdings, Inc. Lewisville, TX), and the FITBONE® intramedullary nail (WITTENSTEIN intens GmbH, Germany).…”

Section: Discussionmentioning

confidence: 99%

“…Occasionally, an intramedullary device is used to augment lengthening and decrease the total time needed in an external fixation device. This strategy has been shown to have favorable results compared to external fixation-only methods [ 13 , 15 , 17 , 18 , 23 – 25 ]. While newer intramedullary nail-only lengthening techniques have been introduced for orthopedic surgeries, these are designed primarily for intact limb lengthening [ 26 – 28 ].…”

Section: Introductionmentioning

confidence: 99%

Novel intramedullary device for lengthening transfemoral residual limbs

et al. 2017

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BackgroundLower limb loss is a highly disabling medical condition that can severely impact a person’s quality of life. Recovery becomes especially challenging if an amputee has a short residual limb, which can complicate proper prosthetic fitting, causing discomfort, difficulties in suspension, and reduced mobility. Current limb lengthening techniques such as the Ilizarov apparatus and external fixators are cumbersome, uncomfortable, and have high complication rates. In this study, we investigated the effectiveness of a novel limb-lengthening device that uses intramedullary bone lengthening and requires only one percutaneous rod at the end of the limb during the distraction phase. Only the intramedullary nail remains after the distraction phase, and no external components are required during the consolidation phase. We hypothesize that this system would create a much easier experience for the patient.MethodsThe system was first tested in a mock surgical implantation using plastic femur bones. The device was then tested in a series of cadaveric experiments using pelvis-to-knee specimens by a group of surgeons. Surgeons evaluated the surgical insertion technique, soft tissue considerations, hardware fixation strategies, and the effectiveness of the distraction mechanism. Revisions and improvements to the device and surgical procedure were made based on the results from the cadaveric experiments.ResultsA questionnaire was given to two visiting surgeons following the final iteration of the device. The surgeons reported that the system effectively lengthened the limb, was sturdy, and could be installed efficiently. However, there remains a risk of infection and soft tissue imbalances, similar to that introduced by an external fixator device. Suggestions on how to improve the design of the device and mitigate infection through postoperative management and surgical standard of care will be considered for future clinical trials.ConclusionsThe described intramedullary residual limb-lengthening device has evolved from a prototype to a mature model tested in six cadaveric experiments to date. Further mechanical and functional testing is needed to finalize the device before testing in patients.

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“…Nonetheless, osteogenesis by distraction as described by Ilizarov is still how lengthening is achieved [3]. Internal lengthening nails (ILN) have the advantage of eliminating the need for external fixators and their associated complications [4][5][6]. Among the lengthening devices, magnetic intramedullary nails offer the most accurate distraction and precise lengthening [1,2,4,[6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Combined antegrade femur lengthening and distal deformity correction: a case series

Jardaly

Gilbert

2021

J Orthop Surg Res

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Background Leg length discrepancy is often associated with distal femur angular deformities such as valgus or flexion. This study aims to report a new technique for simultaneous limb lengthening and acute distal femoral angular correction. Methods A retrospective chart review of patients undergoing a single procedure was conducted. Patients included had a single operation where they underwent distal femur osteotomy stabilized with a plate followed by antegrade nailing with a magnetically controlled intramedullary lengthening nail (PRECICE, Ellipse Technologies, Inc., Irvine, CA, USA) using a trochanteric entry. Results Seven femurs from 7 patients were included. The average age at operation was 13.6 years, and the leg length difference was 51 mm (range 30–105 mm). Associated deformities were valgus (4), knee flexion contracture (2), and both valgus and flexion contracture (1). Lengthening achieved was 43 mm (P = 0.0036), with a consolidation index of 27 days/cm and reliability of 0.87 (6/7). The 5 patients with angulation had an improvement of valgus from 12 to 4° (P = 0.006) and of the mechanical axis deviation from 34 to 3 mm (P = 0.0001). The range of motion also improved in the 3 patients with contractures. Preoperative gait disturbance, hip and knee pain, and functional scoliosis resolved after the limb deformities were corrected. Conclusion Combining a magnetic internal lengthening nail with a second distal osteotomy stabilized with a plate can successfully correct limb length and distal femur deformity acutely without altering the expected result of each procedure.

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Femoral Lengthening Over a Pediatric Femoral Nail

Abstract: Level IV-Case Series.

Cited by 33 publications

References 21 publications

Submuscular Plate Stabilisation After Lengthening: Standard and Modified Techniques

Submuscular Plate Stabilisation After Lengthening: Standard and Modified Techniques

Novel intramedullary device for lengthening transfemoral residual limbs

Combined antegrade femur lengthening and distal deformity correction: a case series

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