Leg lengthening over an intramedullary nail

Abstract

D istraction osteogenesis is widely used for leg lengthening, but often requires a long period of external fixation which carries risks of pin-track sepsis, malalignment, stiffness of the joint and late fracture of the regenerate. We present the results of 20 cases in which, in an attempt to reduce the rate of complications, a combination of external fixation and intramedullary nailing was used. The mean gain in length was 4.7 cm (2 to 8.6). The mean time of external fixation was 20 days per centimetre gain in length. All distracted segments healed spontaneously without refracture or malalignment. There were three cases of deep infection, two of which occurred in patients who had had previous open fractures of the bone which was being lengthened. All resolved with appropriate treatment. This method allows early rehabilitation, with a rapid return of knee movement. There is a lower rate of complications than occurs when external fixation is used on its own. The time of external fixation is shorter than in other methods of leg lengthening. The high risk of infection calls for caution.

Verl�ngerung der unteren Extremit�t mit dem Intramedullary Skeletal Kinetic Distractor (ISKD)

“…Die prinzipielle Problematik der Pintraktinfektion, Gewebetransfixation, verminderten Gelenkbeweglichkeit und Narbenbildung bleibt jedoch bestehen. Infektionen um die Pins, die sich entlang dem Nagel im Markraum ausbreiten, können eine schwere Markraumphlegmone auslösen [17,23].…”

“…However, the major drawbacks such as pin tract infection, decreased mobility of soft tissues, reduced joint mobility, and scar formation persist. In addition, pin site infections that can spread to the medullary canal along the nail and lead to osteomyelitis are further known complications [17,23].…”

Femoral lengthening over elastic stable intramedullary nailing in children using the monolateral external fixator

“…Lengthening over an intramedullary nail is not a recent concept [16], and the use of unlocked Kuentscher nails to control alignment has been previously reported [12].…”

“…With the goal of improving results of this procedure, particularly in terms of reduction of the time of treatment and of the complications rate, and of improving its tolerability, recent works have moved into two directions: lengthenings entirely performed over intramedullary nails [9][10][11] and, on the other side, the association of external fixation with the use of rigid intramedullary nailing [6,[12][13][14][15][16][17], providing to the distraction bone enough stability to remove the fixator at the end of the phase of distraction, thus reducing the duration of external fixation.…”

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

“…Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. [2,4,11,22,23,25]. These lengthening nails provide many advantages such as earlier rehabilitation, reduced risk of deep infections, reduced pain, and more rapid return to normal joint motion and activity, and therefore, improved patient comfort [2, 4, 11-13, 15, 26].…”