FEMORAL LENGTHENING WITH THE INTRAMEDULLARY LENGTHENING NAIL: ANALYSIS OF RESULTS

Abstract

Introduction and Objectives: Our aim is to analyze results using an Albizzia® gradual lengthening intramedullary nail in the femur.

Materials and Methods: From October 1997 to November 2000, 7 femoral lengthenings were performed on 5 patients (2 were bilateral) in our unit, using an intramedullary lengthening nail. Average age was 19 years (15–22). Aetiologies included congenital deformity with symmetric shortening (1 case), fibrous cortical defects (1 case), iatrogenic shortening secondary to trauma (1 case), and 2 cases of symmetric dwarfism (idiopathic drawfism, Turner’s syndrome). Distraction was achieved at 15 cycles/day (1 mm/day). Clinical and radiographic results were evaluated using the Paley criteria, considering the indices of consolidation and distraction. Average follow-up time was 48 months (30–60 months).

Results: Average lengthening obtained was 5.7 cm (4–7 cm), with a distraction period of 99 days (45–214 days) and a distraction index of 0.71 mm/day (17 days/1 cm). In bilateral cases, the distraction index was 0.57 mm/day. Consolidation time was 187 days with a consolidation index of 33 days/cm. Complications included 3 mechanical (2 broken screws and one intramedullary saw failure); one involving bone (1 intraoperative fracture), and one case requiring spinal anaesthesia to achieve lengthening in the first few days. No nerve, joint, or infection-related complications were observed. Average duration of surgery was 2 hours 40 minutes.

Discussion and Conclusions: The use of a gradual intramedullary lengthening nail yields good results, since it is a more stable system which minimises complications compared to external fixators. It is also a more comfortable procedure for the patient.