The importance of reaming the posterior femoral cortex before inserting lengthening nails and calculation of the amount of reaming

Abstract

BackgroundLengthening nails have been used to correct limb length discrepancy caused by different etiologies, as well as for post-traumatic reasons. Two important lengthening nail-related complications are damage to the distraction mechanism and femoral fractures around the nail tip. As a result of the curved anatomy of the femur, straight nails impinge on the anterior cortex. Therefore, proper reshaping of the medullary canal to accommodate straight lengthening nails is crucial for the prevention of this problem. Reaming the dense posterior cortex is important when aiming to insert a lengthening nail without incurring anterior cortex nail tip impingement-related complications. Posterior femoral cortex over-reaming is a solution to this situation.MethodsSixty patients received lengthening nails during 2008–2013, (ISKD, Fitbone, Precice). Posterior cortex rigid-reaming technique was used successfully in 45 retrograde femoral lengthening cases. The preoperatively planned posterior cortex amount was reamed until the impingement was overcome during the operation under fluoroscopic control for each case. Since the preoperative determination of posterior cortex reaming amount is time consuming and operator dependent, we evaluated the X-rays of the patients with computer software and conventional paper-based measurements. The effect of reaming the posterior cortical wall on the inclination of the nail tip to the anterior femoral cortex was detected with measurements on the preoperative and postoperative lateral femoral X-rays by using the CorelDRAW® Graphic Suite X6 software package (Corel, Inc., Ottawa, Ontario, Canada) software. On the same software, X-rays and the posterior reaming amount were also calculated.ResultsThe mean age of the patients was 27 years (11–42), while the mean lengthening was 5.9 cm (2–14). The mean consolidation index was 1.05 (0.75–1.62), and the mean follow-up period was 31 months (range, 18–45 months). The mean distance of the osteotomy site to the intercondylar notch of the femur was 81.2 mm (±16.92). The mean displacement of the nail tip position was 15.42 mm (±4.77) on the measurements on the postoperative X-rays after nail insertion compared to the preoperative simulations on the templates. The mean posterior cortex reaming thickness was 3.68 mm (±1.02).ConclusionsWe derived a formula that allows the required amount of optimal posterior cortex reaming to be determined. No impingement-related complications or nail damage were observed.

Distal femoral flexion deformity from growth disturbance treated with a two-level osteotomy and internal lengthening nail

“…The effect of lengthening the femur along the anatomic axis is to lateralize the mechanical axis [ 23 ], but this seemed to have no radiographic or clinical impact on outcome due to the modest amount of lengthening done in these cases. The BHI was low (24 days/cm), which was in keeping with observations from multiple studies on the ILN in femur reconstruction [ 21 , 24 , 25 ].…”

“…Few studies on retrograde ILN have documented the distance of the distal femoral osteotomy to the intercondylar notch. One study reported an average distance of 81 mm [ 24 ]. Krieg et al [ 25 ] explain that a limitation of retrograde ILN surgery is the need for a distance of 70–110 mm from the joint line to the osteotomy site, the variation being due to differences in femur length between patients.…”

Expression and Mechanism of Interleukin 1 (IL-1), Interleukin 2 (IL-2), Interleukin 8 (IL-8), BMP, Fibroblast Growth Factor 1 (FGF1), and Insulin-Like Growth Factor (IGF-1) in Lumbar Disc Herniation

“…Interleukin 1 (IL-1) regulates immune reaction and inflammation [1,3,14], and expression of IL-1 in a variety of tissue factors is promoted by the synthesis of IL-2, IL-6, and IL-8 related cytokines. Expression of IL-1 in wet arthritis induces cartilage cells surrounding matrix degradation, resulting in cartilage cell apoptosis [18]. In the present study of the process of lumbar disc herniation, the mechanism of cartilage cells apoptosis was found to be the most important process.…”

Incidence of chronic kidney disease in patients undergoing arthroplasty: A systematic review of the literature

“…20-24 One case report was excluded, one that did not meet the definition of CKD, 25 and another because it was a narrative review. 26 Finally, only 3 articles met the eligibility criteria and were included in this review.…”