Lower limb lengthening over an intramedullary nail: a long-term follow-up study of 28 cases

Abstract

Background Limb lengthening using an external fixator requires a long period of external fixation and may be associated with several complications such as axial deformity, fracture of the regenerated bone, and joint stiffness. With the goal of reducing the time of external fixation as well as some of these complications, we performed femoral or tibial lengthening over an intramedullary nail, according to Paley’s technique, in 28 patients, followed up after a mean period of 8 years. Materials and methods Twenty-eight patients treated for lower limb discrepancy by limb lengthening over an intramedullary nail were reviewed from 5 to 11 years after healing of regenerated bone. There were 20 femurs and 8 tibiae, with average age at surgery of 14.2 years and average length inequality of 6.1 cm for femurs and 5.3 cm for tibiae. Results The mean lengthening was 5.8 cm for femurs and 4.8 cm for tibiae. The mean period of radiographic consolidation of the regenerated bone was 6 months for femoral lengthening and 4.5 months for tibial lengthening. At follow-up, we observed 8 excellent results, 15 good results, 4 fair results, and 1 poor result, based on Paley’s evaluation criteria. The main complications were one deep infection, one nonunion of the distracted segment, one breakage of the distal fiche of the external fixator, and one breakage of both distal locking screws of the intramedullary nail. Discussion We believe that limb lengthening over an intramedullary nail still represents a good method to treat limb length discrepancy because it reduces the time of external fixation, prevents axial deformities and fractures of regenerated bone, and allows early rehabilitation. The new intramedullary lengthening nails, which theoretically are the ideal device for treating limb length inequality, are still very expensive and need longer follow-up for definitive evaluation. Level of evidence 4.

Limb lengthening with PRECICE magnetic nail in pediatric patients: A systematic review

“…The principles of the osteogenesis distraction bonded traditionally with the external fixators, considering both monolateral and circular fixators[ 6 , 7 ]. More recently, the deployment of fully implantable systems for limb lengthening has allowed overcoming external fixator-related severities such as pin-site infections, soft tissue tethering, and patient device intolerance during treatment, to name a few[ 8 - 10 ]. Intramedullary nails were initially used in conjunction with external fixation in hybrid techniques such as lengthening over nail or lengthening and then nailing[ 11 , 12 ], in order to reduce fixator time and prevent secondary deformities.…”

Comparison of Intramedullary Magnetic Nail, Monolateral External Distractor, and Spatial External Fixator in Femur Lengthening in Adolescents with Congenital Diseases

“…They did not observe significant differences in clinical outcomes between the study groups (p = 0.37) but emphasized its advantages of lengthening over an intramedullary nail in the decrease in the duration of external fixation, protection against refracture, and earlier rehabilitation. Using this combined technique, the other authors confirmed its usefulness in the lengthening of the femur and tibia, although the rate of deep infections remains high, from 2.4% to 15% [30][31][32].…”

Feasibility of Computer‐Aided Design in Limb Lengthening Surgery: Surgical Simulation and Guide Plates

“…and Tjernström et al . reported intraoperative blood loss ranging from 150 to 600 ml using traditional treatment procedures 22 , 23 . In the present study, the mean intraoperative blood loss volume was significantly lower at 53.58 ± 22.51 (range, 25–87) ml.…”