Femoral lengthening over an intramedullary nail using the external fixator

Song, Hae Ryong; Oh, Chang Wug; Mattoo, Rakesh; Park, Byung Chul; Kim, Sung Jung; Park, Il Hyung; Jeon, In-Ho; Ihn, Joo Chul

doi:10.1080/00016470510030652

Cited by 89 publications

(34 citation statements)

References 18 publications

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“…The DCI is 30-60 days/cm in the femur and varies according to disorder, age, location of osteotomy, whether the limbs underwent previous surgery, and the use of dynamization. [15][16][17][18] From the above values, we see that the pattern type and DCI are unrelated. The reason could be that the presence of both the external fixator and intramedullary nail give a great amount of stability to the femur during distraction, and, as soon as the distraction phase is over, the femur callus is further stabilized by interlocking distally and removal of the fixator.…”

Section: Discussionmentioning

confidence: 91%

Callus patterns in femoral lengthening over an intramedullary nail

Muzaffar¹,

Hafeez²,

Modi

et al. 2011

Journal Orthopaedic Research

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Our objectives were to evaluate callus patterns seen in femoral lengthening over an intramedullary nail by Li classification regarding shape and type and to predict the result while using the nail to reduce the external fixation period and its complications. Eight hundred digital radiographs of 15 patients with 15 segments of femur shortening who underwent femoral lengthening with a monolateral external fixator over an intramedullary nail were analyzed retrospectively by four observers. Each radiograph was studied for callus shape, feature type, and callus density using pixel values. The classification was tested for concurrence and reproducibility by interobserver studies and callus patterns were compared with treatment indices to evaluate how they correlated with the outcome. Mean length gained was 4.5 cm (range: 2-8 cm). External fixator index (EFI) was 21.68 days/cm. Average distraction consolidation index (DCI) was 48.49 days/cm. Fusiform callus was seen in three cases, cylindrical in seven, and lateral in five. The homogenous pathway had higher DCI (43.7) than the heterogeneous pathway (32.9), and mixed pathways making up the rest had a DCI of 50.1. Pixel value of callus showed gradual increase in density until 20-24 weeks, then density gradually fell for 8 weeks, again increased after 32 weeks, again gradually fell, and was comparable to adjacent normal bone by 44-48 weeks. Our results suggest that the Li classification can be satisfactorily applied to lengthening procedures over intramedullary nails. The radiologic pattern and pixel value of regenerate can be correlated with the clinical outcome and can be an aid of prognostic value for the surgeon. Keywords: callus pattern; femoral lengthening; intramedullary nail; callus density; healing pathwayThe most common dilemma of any orthopedic surgeon doing distraction osteogenesis is the reproducible method of ascertaining the progression of osteogenesis and the eventual timing of removal of the external fixator.1,2 Since the constant presence of the fixator has been a source of irritation, pain, and stiffness for most patients, the lengthening done over an intramedullary nail is an aesthetic and biomechanically stable option for early removal. Better patient compliance, rapid improvement in range of joint movement, additional construct stability, and reduced incidence of deformities are advantages of such a procedure.3 Routinely, the consolidation phase is two to four times the duration of the distraction phase. Hence, accurate assessment of the mineralization of the regenerate assumes significance considering that inaccurate timing of removal may lead to stiffness and pin tract infection or deformity, shortening, and non union. Li et al. 4 developed a classification based on the shape and pattern of regenerate that, according to them, can help the surgeon to diagnose a particular abnormal callus pattern to determine its etiology, and with early intervention improve the end result. In the Li et al. 4 study, callus patterns were described in the adu...

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Section: Discussionmentioning

confidence: 91%

Callus patterns in femoral lengthening over an intramedullary nail

Muzaffar¹,

Hafeez²,

Modi

et al. 2011

Journal Orthopaedic Research

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“…Nakase et al 26 in their series (n = 14 limbs; 7 femurs and 7 tibias) reported the complications of superficial pin tract infection (4 segments), deep infection (1 segment), secondary deformity in regenerate bone after lengthening (2 segments), and fracture after fixator removal (1 segment). Song et al 10 in their series of femoral lengthening over nail reported 3 cases of deep infection and required early removal of the nail. Ganger et al 25 in their series reported 36 implant-related complications.…”

Section: Discussionmentioning

confidence: 99%

“…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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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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“…19 These techniques have shown to reduce the duration of time in external fixator, but are associated with complications such as failure or incarceration of the nail and osteomyelitis. 29,30 Our fracture rate of 4.5% remains acceptable without this combined technique, although it is an option to be considered in select cases. Also the bone healing index in our study was 47.2 days/cm which is similar to femoral lengthening over an intramedullary nail with an external fixator (43 days/cm).…”

Section: Discussionmentioning

confidence: 93%

Regenerate bone fracture rate following femoral lengthening in paediatric patients

Burke

Cassar-Gheiti

Jia-ju

et al. 2017

Journal of Children's Orthopaedics

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PurposeFemoral lengthening using a circular or mono-lateral frame is a commonly used technique. Fracture at the site of the regenerate bone is a major concern especially following removal of the external fixator. This aim of this study was to assess the rate of fracture of the regenerate bone in this single surgeon series of paediatric patients and determine potential risk factors.MethodsRetrospective review of all the femoral lengthening performed by the senior author was performed. The medical and physiotherapy notes were reviewed. The gender, age at time of surgery, disease aetiology, total days in the external fixator and length of the new regenerate bone were recorded. Patients who sustained a regenerate fracture were identified.ResultsA total of 176 femoral lengthening procedures were performed on 108 patients. Eight regenerate fractures occurred in seven patients (4.5%). The mechanism of injury was a fall in five cases and during physiotherapy in three cases. The regenerate fracture occurred a median number of nine days following removal of frame. There was no significant difference between gender, age at time of surgery, total time in external fixator between those who sustained a regenerate fracture and those patients who did not. A significant difference was noted between the amount of lengthening between the ‘regenerate fracture group’ and the ‘no fracture group’ (50 mm vs 38 mm, respectively; p = 0.029). There was no association between disease aetiology and risk of regenerate fracture.ConclusionsFemoral lengthening of more than 50 mm increases the risk of a fracture at the regenerate site regardless of the disease aetiology. We recommend avoidance of aggressive physiotherapy for the initial four weeks following external fixator removal.

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Femoral lengthening over an intramedullary nail using the external fixator

Cited by 89 publications

References 18 publications

Callus patterns in femoral lengthening over an intramedullary nail

Callus patterns in femoral lengthening over an intramedullary nail

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

Regenerate bone fracture rate following femoral lengthening in paediatric patients

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