Abstract
Background
Mechanically activated intramedullary lengthening nails are advantageous over external
fixator. However, difficulties with the control of the distraction rate are the main
drawbacks, which may in turn cause insufficient bone regenerate.
Patients and methods
A total of 57 lengthening procedures were performed using intramedullary skeletal
kinetic distractor (ISKD) nail in 53 patients (femoral = 45 and tibial = 12). Average length gain was 4.3 ± 1.6 cm. The cause of shortening was post-traumatic (n = 33), congenital (n = 20), post-tumour resection (n = 1), cosmetic femoral lengthening (n = 2) and post-correction of distal femoral varus deformity (n = 1).
Results
The desired lengthening was achieved in all patients. The mean follow-up period was
23 ± 12 months. The healing index for patients with normal bone healing was 1.2 ± 0.32 months/cm. Complications in femoral lengthening were superficial wound infection (n = 1), premature consolidation (n = 4) and insufficient bone regenerate (n = 11), while in the tibial lengthening, two developed equinus contractures, one had
compartment syndrome following implantation of the nail and one insufficient bone
regenerate. Furthermore, nine runaway nails and three non-distracting nails were present
in the femoral lengthening. One non-distracting nail responded to manipulation under
anaesthesia, one required exchange nailing and accidental acute lengthening of 3 cm took place while manipulating the third nail. Patients with femoral lengthening
and those with insufficient regenerate had significantly higher distraction rates
(P = 0.006 and 0.003, respectively). Six out of the nine runaway nails developed insufficient
bone regenerate. In addition, 10.7-mm tibial ISKD nails were found to have lower rates
of runaway nails compared with other used diameters.
Conclusion
We emphasise the rule of distraction rates above 1.5 mm/day in the development of insufficient bone regenerate. Distraction problems with
these nails are mostly due to dysfunction within the ratcheting mechanism, which may
be related to the diameter of the nail. New designs for mechanically activated nails
with a better control mechanism for the distraction rate are required.
Keywords
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References
- Basic Science and Biological Principles of Distraction Osteogenesis.in: Robert Rozbruch S. Ilizarov S. Limb lengthening and reconstruction surgery. Informa Healthcare, New York2007: 19-42
- First fully implantable intramedullary system for callus distraction–intramedullary nail with programmable drive for leg lengthening and segment displacement: principles and initial clinical results.Chirurg. 1990; 61: 605-609
- The intramedullary skeletal kinetic distractor (ISKD): first clinical results of a new intramedullary nail for lengthening of the femur and tibia.Injury. 2001; 32: SD129-SD139
- Complications of limb lengthening: a learning curve.Clin Orthop Relat Res. 1994; : 10-18
- Osteoneogenesis and its influencing factors during treatment with the Ilizarov method.Clin Orthop Relat Res. 1996; : 261-272
- Variables affecting time to bone healing during limb lengthening.Clin Orthop Relat Res. 1994; : 31-37
- Mechanical characterization of a totally intramedullary gradual elongation nail.Clin Orthop Relat Res. 1997; : 281-290
- Gradual femoral lengthening with the Albizzia intramedullary nail.J Bone Joint Surg Am. 2003; 85-A: 838-848
- Limb lengthening with the Intramedullary Skeletal Kinetic Distractor (ISKD).Oper Orthop Traumatol. 2005; 17: 79-101
- Improved comfort in lower limb lengthening with the intramedullary skeletal kinetic distractor: principles and preliminary clinical experiences.Arch Orthop Trauma Surg. 2004; 124: 129-133
- The tension-stress effect on the genesis and growth of tissues. Part I. The influence of stability of fixation and soft-tissue preservation.Clin Orthop Relat Res. 1989; : 249-281
- The tension-stress effect on the genesis and growth of tissues. Part II. The influence of the rate and frequency of distraction.Clin Orthop Relat Res. 1989; : 263-285
- Insufficient bone regnerate after intramedullary femoral lengthening: risk factors and classification system.Clin Orthop Relat Res. 2010; ([Epub ahead of print])
- Early complications encountered using a self-lengthening intramedullary nail for the correction of limb length inequality.Joint Dis Rel Surg. 2007; 18: 52-57
- Limb lengthening with a fully implantable mechanical distraction intramedullary nail.Z Orthop Ihre Grenzgeb. 2006; 144: 419-426
- Femoral lengthening with the Intramedullary Skeletal Kinetic Distractor.J Bone Joint Surg Br. 2009; 91: 955-961
Article info
Publication history
Accepted:
June 21,
2010
Identification
Copyright
© 2010 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
