The management of leg-length discrepancy in Ollier’s disease with a fully implantable lengthening nail

Baumgart, R; Bürklein, Dominik; Hinterwimmer, Stefan; Thaller, Peter Helmut; Mutschler, Wolf

doi:10.1302/0301-620x.87b7.16365

Cited by 54 publications

(41 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…2 cm to max. 17.4 cm) for Ilizarov ring fixators (IRF) [48,57,58] and intramedullary nails [16,46,50,[59][60][61][62][63][64] and around 2.5-3 cm (min. 8 mm to max.…”

Section: Indications For Leg Lengtheningmentioning

confidence: 99%

Current concepts of leg lengthening

Hasler

Krieg

2012

Journal of Children's Orthopaedics

101

View full text Add to dashboard Cite

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.

show abstract

“…2 cm to max. 17.4 cm) for Ilizarov ring fixators (IRF) [48,57,58] and intramedullary nails [16,46,50,[59][60][61][62][63][64] and around 2.5-3 cm (min. 8 mm to max.…”

Section: Indications For Leg Lengtheningmentioning

confidence: 99%

Current concepts of leg lengthening

Hasler

Krieg

2012

Journal of Children's Orthopaedics

101

View full text Add to dashboard Cite

show abstract

“…Callus distraction by intramedullary lengthening has become an alternative treatment method for limb lengthening during the last 5 years [4,6,9,14,19,21,27,37]. Few data have been published concerning the FITBONE 1 TAA for intramedullary leg lengthening [4,6,37].…”

Section: Discussionmentioning

confidence: 99%

“…Few data have been published concerning the FITBONE 1 TAA for intramedullary leg lengthening [4,6,37]. The concept that led to the development of techniques using intramedullary nails for callus distraction was to achieve leg lengthening with faster rehabilitation and a lower rate of complications [3,9,19].…”

Section: Discussionmentioning

confidence: 99%

“…These patients underwent leg lengthening with a fully implantable, motorized intramedullary nail system (FITBONE 1 Telescope Active Actuator nail [TAA]; WITTENSTEIN intens 1 GmbH, Igersheim, Germany) ( Fig. 1) introduced by Baumgart et al [4][5][6]. Patients were selected according to the following criteria.…”

Section: Methodsmentioning

confidence: 99%

“…These measurements were made under conditions based on the preoperative standard protocol for retrograde corrective planning described by Baumgart et al [4,6]. Different from conventional trauma nails, the femoral FITBONE 1 TAA is straight, which must be considered in preoperative planning.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Leg Lengthening With a Motorized Nail in Adolescents

Krieg

Speth

Foster

2008

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Leg lengthening by external fixation is associated with various difficulties. We evaluated eight adolescent patients who underwent leg lengthening with a motorized intramedullary lengthening device. We asked whether this method could reduce the time of hospitalization and rehabilitation and whether the incidence of complications commonly associated with external fixators could be reduced. We compared our preliminary results with those from other reports, with a focus on leg length achieved, time of rehabilitation, and rate of complications. The average leg-length discrepancy was 3.8 cm (range, 3-5 cm). The average lengthening distance was 3.8 cm (range, 2.9-4.7 cm). In six patients, leg lengthening was combined with successful correction of the mechanical axis alignment. The consolidation index averaged 26 days/cm (range, 19-41 days/cm). The average hospital stay was 9.6 days. No bone or soft tissue infections were observed. In comparison to other studies (1.0-2.8 complications/ patient), our results suggest that the difficulties commonly associated with external fixators can be reduced with this method. It also allows good angular correction in patients with mechanical axis deviation. These features combined with a short time of hospitalization and rehabilitation make it a promising procedure for limb lengthening.

show abstract

Multi‐Axis Fatigue Experimentation System of Intramedullary Implants for Femur and Tibia

Kanerva

Pärnänen

Jokinen

et al. 2019

Journal Orthopaedic Research

View full text Add to dashboard Cite

Current designs of leg-lengthening implants have faced serious failures due to inadequacies in the mechanical design. The failure typically is the result of fatigue induced by a combined loading condition with axial and shear components acting in the tubular body of the implant. One of the reasons leading to the failure is improper verification testing for the design of the fatigue limit. The current test standards for pre-clinical design phases of nail implants are relatively straightforward and widely accepted yet cannot produce the three-dimensional stress state representative of the anticipated operation in a patient during the consolidation phase. This work introduces a major improvement toward a method for verifying fatigue life of tubular as well as solid implants under combined torque, axial load, and bending. The report describes a new loading fixture, a calibration method, and compares the qualification results of finite element simulation analyses and experimental measurements during cyclic loading tests. The findings state that the fixture produces controlled multi-axial loadings to study varied osteotomy locations, quasi-static strength and fatigue of intramedullary implants at an intermediate, 2 Hz, cycle rate.

show abstract

The management of leg-length discrepancy in Ollier’s disease with a fully implantable lengthening nail

Cited by 54 publications

References 8 publications

Current concepts of leg lengthening

Current concepts of leg lengthening

Leg Lengthening With a Motorized Nail in Adolescents

Multi‐Axis Fatigue Experimentation System of Intramedullary Implants for Femur and Tibia

Contact Info

Product

Resources

About