127. ROLE OF STABLE ELASTIC CENTROMEDULLARY NAILING FOR BONE LENGTHENING IN CHILDREN: A COMPARATIVE STUDY OF 295 LENGTHENINGS

Abstract

Purpose of the study: There is a link between complications and duration of instrumentation. Since 2001, we have associated circular external fixation (EF) and stable elastic centromedullary nailing (SECMN) to shorten the duration of the external fixation in bone lengthening in children. This study was designed to assess the results of the EF+SECMN for this indication.

Material and methods: From 2001 to 2009, progressive bone lengthening was performed in 250 children aged 3 to 16 years. There were 295 progressive lengthening procedures involving 339 segments. Indications were congenital (n=163) and acquired (n=87) length discrepancy. In group I (195 lengthenings, 222 segments), the Ilizarov EF was used alone. In group II, the Ilizarov (n=92, 108 segments) or the TSF (n=8, 9 segments) EF was associated with SECMN. After insertion of the EF, the centromedullary nails were introduced after the osteotomies. The healing date was the date the EF was removed; the nails were left in place to protect the bone. The healing index was calculated from duration of the EF (in days) divided by lengthening (in cm).

Results: Use of SECMN shortens the duration of EF irrespective of the aetiology, the segment, the lengthening method (mono- or polysegmental, mono- or poly-focal), with a statistically significant difference between the two groups (gain of 6 to 12 d/cm). In group I, deformities or fractures of the regenerated bone after removal of the EF occurred in 21 cases (10.77%), deep infections in 4 (2.05%), osetomyelitis in 2 (1.03%). In group II, the only complications were late healing (1%) and 10° angulation at the lengthening site (1%). The centromedullary nails migrated in eight patients, with no impact on the lengthening results.

Discussion: With SECMN, the lengthening procedure is achieved with an elastic but resistant system. It is hypothesised that this system stimulates osteogenesis since the healing index is improved. SECMN does not prevent progressive correction of shaft or diaphyseal deviations. By shortening the duration of external fixation, this method had a great impact on reducing serious complications such as fractures and deep infections.

Conclusion: SECMN can considerably reduce the duration of external fixation during bone lengthening procedures in children and reduce (or eliminate) most of the serious complications.