Insufficient Bone Regenerate after Intramedullary Femoral Lengthening: Risk Factors and Classification System

Kenawey, Mohamed; Krettek, Christian; Liodakis, Emmanouil; Meller, Rupert; Hankemeier, Stefan

doi:10.1007/s11999-010-1332-6

Cited by 72 publications

(67 citation statements)

References 25 publications

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“…The mean healing index in our study was 0.91 months/cm, which is better than other results in the literature. Kenawey et al [20] reported a mean healing index of 1.2 months/cm using the ISKD and Catagni et al [7] reported a mean healing index of 1.5 months/cm using the Ilizarov.…”

Section: Discussionmentioning

confidence: 99%

“…The other method that has been previously used is the ISKD, which is the only intramedullary device for lengthening that has been in general use in United States. This method is associated with several complications, such as premature or delayed consolidation with difficulties in controlling the distraction rate rhythm, implant breakage, and mechanical failure [9,20,22,35,36]. Mahboubian et al [22] reported complications requiring additional surgeries such as exchange nailing or removal of the ISKD in six of 12 patients.…”

Section: Discussionmentioning

confidence: 99%

“…For the past 10 years, the only FDA-approved intramedullary lengthening device has been the Intramedullary Skeletal Kinetic Distractor (ISKD) (Orthofix Inc, Lewisville, TX, USA). However, intramedullary lengthening is associated with complications, including premature or delayed consolidation with difficulty in controlling the rate of distraction, implant breakage, and mechanical failure [9,16,[20][21][22]35].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Internal Lengthening Device for Congenital Femoral Deficiency and Fibular Hemimelia

Shabtai

Specht

Standard

et al. 2014

Clin Orthop Relat Res

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Background Patients with congenital limb shortening can present with joint instability, soft tissue contractures, and significant leg length discrepancy. Classically, lengthening is done with external fixation, which can result in scarring, pin site infection, loss of motion, and pain. We therefore developed an alternative to this approach, a new, controllable, internal lengthening device for patients with congenital limb shortening.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Internal Lengthening Device for Congenital Femoral Deficiency and Fibular Hemimelia

Shabtai

Specht

Standard

et al. 2014

Clin Orthop Relat Res

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“…It is the main underlying cause of premature consolidation, which is about 12 % for ISKD [51,53,151], compared to below 5 % for all the other implants [16,50,53]. Runaway nails unintentionally lengthen more than 1.5 mm/day, a problem encountered in around 10 % of ISKDs [19,51,52,55]; one patient even underwent accidental 3 cm lengthening during manipulation under anaesthesia [51] and another expanded to 4 cm unintended length during the first 2 weeks [52]. Bolt loosening [63] and problems with locking screws [66] are obstacles without permanent consequences.…”

Section: Outcomes and Complicationsmentioning

confidence: 99%

“…runaway nail), age [30 years, smoking, gain [4 cm, osteotomy at the same site of previous trauma or surgery and acute correction of associated deformities may be associated factors [19,53,63]. Partial or complete bony defects have been reported in up to 22 % for ISKD nails [19,51], mostly due to inadvertent higher distraction rates (1.5 vs 1.1 mm). Pseudarthrosis is a nonevent in most series [53,60,62].…”

Section: Outcomes and Complicationsmentioning

confidence: 99%

Current concepts of leg lengthening

Hasler

Krieg

2012

Journal of Children's Orthopaedics

101

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Any lower limb discrepancy may be equalised by conservative means (insoles, prosthesis and orthosis). However, their long-term acceptance is low in regard to function, costs, expenditure and appearance. Timely epiphysiodesis is the best option in uniplanar deformities with adequate remaining growth and for patients whose predicted final body height is above the 50th percentile. However, many patients present late or with multi-planar deformities, which warrant more sophisticated operative approaches. The history of surgical bone lengthening comprises 100 exciting years of struggling, development and ongoing learning. The initial strategy of acute or rapid incremental distraction had lasted almost half a century until Ilizarov recognised the benefits of biological periosteum-preserving osteotomies and incremental lengthening at slow rates (1 mm/day) at a 4 × 0.25-mm daily rhythm, well appreciated as callotasis. In parallel, ring and wire constructs made complex three-dimensional axial, translational and rotational bone moulding possible. Taylor Spatial Frames—built on hexapod strut-linked platform technology as known from flight simulators—took limb correction to a more reliable, more precise and aesthetical level, all the more that the whole process became web-based. It represents state-of-the-art methodology and technology for complex, multi-plane deformities. Due to the significant risk of secondary malalignment, indications for lengthening by unilateral fixation have shrunken to moderate amounts of length disparity and uni- to bi-planar deformities in patients with still open physes. Mechanical or motorised, minimally invasively placed nails prevent muscle fixation and, therefore, ease rehabilitation, increase patient comfort and potentially shorten the overall time of sick leave and refrain from sports activities. Hence, they offer a valuable alternative for low-grade complexity situations. It remains to be proved if the significantly higher implant costs are compensated by lower treatment costs. Overall, limb lengthening, particularly in combination with multi-planar deformity correction, can still be an arduous endeavour. In any case, wise judgement of the patient’s deformity, medical and biological situation, psychosocial environment, selection of the appropriate method and hardware, as well as meticulous operating technique by an experienced surgeon are the cornerstones of successful outcomes.

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Limb Deformity

Kenawey

Ali

2021

Pediatric Orthopedics for Primary Healthcare

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Insufficient Bone Regenerate after Intramedullary Femoral Lengthening: Risk Factors and Classification System

Abstract: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Cited by 72 publications

References 25 publications

Internal Lengthening Device for Congenital Femoral Deficiency and Fibular Hemimelia

Internal Lengthening Device for Congenital Femoral Deficiency and Fibular Hemimelia

Current concepts of leg lengthening

Limb Deformity

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