Leg lengthening using intramedullay skeletal kinetic distractor: Results of 57 consecutive applications

Kenawey, Mohamed; Krettek, Christian; Liodakis, Emmanouil; Wiebking, Ulrich; Hankemeier, Stefan

doi:10.1016/j.injury.2010.06.016

Cited by 74 publications

(62 citation statements)

References 9 publications

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“…[48][49][50]. The composition of causes varies [12,[51][52][53][54][55]. Some series include bilateral lengthening for short stature, which is not the focus of this article [54].…”

Section: Indications For Leg Lengtheningmentioning

confidence: 99%

“…There seems not to be a difference between femoral and tibial lengthenings, not between congenital and acquired problems but higher age, severity of deformity, unilateral fixation and amount of acute correction may have some additional negative impact [13,154]. The figures for complications according to Paley [22] are biased, since IRF and TSF are commonly used for more complex cases: they range from 46 to 72 % for external fixation [13,17,22], up to 60 % for LON [60], are around 29 % [16,49] for Albizzia nails, 31-50 % [51,55] for ISKD and 12.5-27 % [56,63] for Fitbone nails.…”

Section: Outcomes and Complicationsmentioning

confidence: 99%

“…However, the latter may also exhibit technical problems like broken wire and motor failure, blocked motor and running backs in up to 10 % [46,54,56,63]. Nail blockage also occurred in Albizzia series [16] and ISKD nails [51]. 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].…”

Section: Outcomes and Complicationsmentioning

confidence: 99%

“…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%

See 4 more Smart Citations

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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“…[48][49][50]. The composition of causes varies [12,[51][52][53][54][55]. Some series include bilateral lengthening for short stature, which is not the focus of this article [54].…”

Section: Indications For Leg Lengtheningmentioning

confidence: 99%