PROGRESSIVE LENGTHENING OF THE FEMUR WITH A CENTROMEDULLARY NAIL: A RETROSPECTIVE SERIES OF 14 PATIENTS

Abstract

Purpose: External fixators are widely used for limb lengthening procedures. More recently the femoral nail has been introduced combining the advantages of progressive lengthening obtained with external fixation and of the percutaneous approach of internal fixation. This retrospective analysis of 14 patients treated with the progressive femur lengthening nail (ECMP) Albizzia®, was conducted to analyse results in terms of limb length correction, bone healing and complications.

Material and methods: The fourteen patients, nine men and five women, mean age 27.3 years had leg length discrepancies = 20 cm. All were treated with the ECMAP nail (Albizzia®)in January or February 2000. There were nine right legs and five left legs. The patients had discrepancy subsequent to trauma (64.3%), hip dysplasia (21.4%) or neurological (7.15%) or infantile (7.15%) conditions. Mean leg length discrepancy was 41.5mm (20–150 mm); 57.1% of the patients wore a raised heal and 14.2% used crutches. The nail was inserted with reaming and locked on both ends. The corticotomy was made with an endomedullary saw in a closed procedure for 78.5% of the patients and with an open procedure for 21.5%. Angular correction was associated in 32.7% of the cases. Outcome was analysed on the basis of operative time, blood loss, rhythm and amount of limb lengthening, delay to healing and complications.

Results: Mean follow-up was 25 months. Mean operative time was 2 hr 28 min. The lengthening procedure began 4.1 days after nailing with, on the average, 20 ratchet clicks per day. Mean duration of the lengthening procedure was 32.5 days. Mean lengthening was 32.15 mm, i.e. 0.99 mm/day. Ten patients had a general anaesthesia at least twice to manipulate the nail ratchet. There were five cases with mechanical complications and one case of regressive nerve injury. There were no infections, no cases of joint stiffness and no axis defects. Bone healing was achieved a mean 2.7 days. There was one nonunion. Mean haemoglobin loss was four points, three patients required transfusion. Limb length was equivalent in six patients, with < 5 mm discrepancy in three, 6–10 mm discrepancy in one, 11 mm discrepancy in two and 64 mm discrepancy in one. One lengthening procedure had to be interrupted before term.

Discussion: ECMAP is unable to avoid the complications inherent in lengthening procedures but does offer undeniable advantages over external fixation. The risk of infection is very low and skin scars are minimal. Patient comfort is greatly improved (elimination of the cumbersome external fixator). Delay to bone healing is satisfactory and axial rotation defects can easily be corrected. This technique appears to be an excellent means for lengthening the femur in trauma patients.