Abstract
The goal of this paper is to compare the results and complication namely infection rates, of the techniques of Standard Ilizarov lengthening, lengthening over nail (LON) and lengthening then nailing (LTN) utilizing a standard nail (STD) and a special nail with a core of cement releasing antibiotics (SAFE).
In a first study done between 1993 and 2008, we have compared 25 patients treated with lengthening with a Ilizarov frame (LIF) with 26 patients where a standard nail was used to do a lengthening over nail technique (LON).
From 2009 and 2012 we have utilized the SAFE nail in 17 patients to perform lengthening over nail (SAFE-LON) and lengthening then nailing (SAFE-LTN) techniques. 7 patients had a pseudarthrosis, 5 a malconsolidation with shortening and or axial deviation and 5 a bone loss after infection of total knee replacements.
We used a lengthening over nail in 4 cases, a lengthening and axial correction then nailing in three, acute compression and proximal lengthening then nailing in five patients and knee arthrodesis and femoral or tibial lengthening then nailing in another 5 cases. We have used a Ilizarov frame in all cases.
We found that with LON technique, the external fixation time was 3 times lower, promoting the recovery of full range of knee mobility in half the time, comparatively with LIF technique, with statistically very significant differences.
We found a rate of 30% of intercurrences on the LON group and 24% in the Ilizarov, difference that was not statistically significant. 3 patients got bone infection after LON technique, a rate of 11.5%. Late consolidation and fracture of regenerate appeared only in the Ilizarov technique group, whereas in the LON technique we had 3 cases of premature consolidation of the regenerate.
In the SAFE-LON and SAFE-LTN techniques utilizing the SAFE nail with antibiotics, we found a decrease of the overall intercurrence rate from 30% to 12% and namely, bone infection was cured or didn't appeared after nailing with this new device in all cases.
LON and LTN techniques are somehow more demanding, but much more comfortable for the patient, which need to carry the frame for less time, It permits an earlier return to activity, about half the time, it controls better delayed regenerate and its fracture does not increase complication rate and costs of treatment and prevents infection when converting from external to internal fixation.
