Introduction

Stryde® lengthening nail has been recently withdrawn because of concerns about osteolysis and other bone lesions that have been observed early after implantation. The present study analyses the incidence and features of these bone lesions in our patients.

Introduction

Management of deformity involving limb length discrepancy (LLD) using intramedullary devices offers significant benefits to both patients and clinicians over traditional external fixation. Following the withdrawal of the PRECICE nail, the Fitbone became the primary implant available for intramedullary lengthening and deformity correction within our service. This consecutive series illustrates the advantages and complications associated with the use of this device, and describes a novel technique modification for antegrade intramedullary lengthening nails.

Limb length deficiency, secondary to trauma or infection, is a common reason for referral to our tertiary service. After experiencing troubles with the Intramedullary Skeletal Kinetic Distractor (ISKD), we changed implant to the magnet operated Precice nail. We evaluated the safety and reliability of this novel device and compared it to our early ISKD results.

To minimise variables, we selected femurs only. In total, we reviewed medical and radiographic records of 20 cases (8 ISKD, 12 Precise) from 2010–2015. At each postoperative visit, the accuracy and precision of distraction and complications were recorded. Accuracy reflected how close the measured lengthening was to the prescribed distraction at each postoperative visit. Precision reflected how close the repeated measurements were to each other over the course of total lengthening period. No patients were lost to follow-up (1–3.5 years).

With the Precice nail (2012–2015), 11/12 were male and 10/12 were caused by trauma. The mean age was 34. Mean total lengthening was 38mm (range, 29–53mm), with an accuracy of 98percnt; and precision of 92percnt;. All patients achieved target lengthening at a rate of 1mm lengthening per day. In one case, the Precice nail fractured and this was revised successfully. With the ISKD group (2010–2012), 8/8 had complications (magnet jamming, nail breakage, equinus contractures and claw toes), with 25percnt; achieving accurate lengthening and precision of 38percnt;.

Our results so far have justified our change in implant choice and, in our experience, support the Precice nail as being safe and precise.

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.

Background:

External fixators are not as well tolerated around the femur when compared to the tibia. Lengthening with an intramedullary device is therefore attractive.

Background. Lengthening over nail (LON) and the use of internal lengthening nails have been developed to minimize patients' time in a frame during femur lengthening. This study compares the outcomes of two techniques of femur lengthening, LON and Intramedullary Skeletal Kinetic Distraction (ISKD). Methods. In this retrospective study, 12 consecutive ISKD procedures were performed for femoral lengthening and followed for an average of 76 months. After the ISKD group, 20 consecutive femoral lengthening procedures were performed as an LON technique and followed for an average of 27 months. Results. There was no significant difference in achieving the lengthening goals between the two procedures. The healing index for the LON group averaged 1.4 months/cm, while the ISKD group was 3.2 months/cm (p=0.242). The distraction rates for the ISKD had a fast group (>1mm/day) with an average distraction rate of 1.7 mm/day and a slow group (<1mm/day) with a distraction rate of 0.84 mm/day. The LON group had an average distraction rate of 0.88 mm/day (p<0.001). The incidence of complications that required further unanticipated surgeries for the LON group was 1/20 (5%), while the ISKD group had complications in 6/12 femurs (50%, p=0.004). Conclusions. We concluded that the LON technique is a more predictable and reliable method for femoral lengthening than the ISKD

Purpose: During the second half of the 80s, Grammont, Trouilloud and Guichet developed a centromedullary nail for progressive limb lengthening. We analysed retrospectively twenty lengthenings, studying the clinical and radiological results to examine the quality of callus formation.

Material and methods: This study included eighteen patients, thirteen men and five women, who underwent lengthening procedures between 1991 and 2000. The patient’s clinical files were analysed in addition to the results of a physical examination. A standardised x-ray protocol was used to analyse bone regeneration.

Results: Mean follow-up was 4.55 years (1.5–10.5). Mean lengthening was 46 mm (30–80) achieved at a mean rate of 1.28 mm/d. The Bastiani index was 26 j/cm. Complications were: one progressive external popliteal sciatic palsy, one persistent knee flexion, one premature callus consolidation, and two callus fractures after nail removal. All patients maintained their activity level. The quality of regenerated bone was better in the dorsal and medial segments exposed to more stress. The callus was cortical and remodelled after removal of the nail.

Discussion: Like all lengthening techniques, the Albizzia nail requires careful preoperative planning, particularly to determine the level of the endomedullary osteotomy. The clinical results in this series were globally satisfactory. The callus was similar to cortical bone and quite different from the callus obtained with external lengthening methods, but our study demonstrated the excellent quality of the regenerated bone. The Albizzia nail can also be left in place until a solid reliable callus has formed, an advantage compared with external fixation which is less well tolerated.

Introduction. Motorised intramedullary lengthening nails are considered more expensive than external fixators for limb lengthening. This research aims to compare the cost of femoral lengthening in children using the PRECICE magnetic lengthening nail with external fixation. Materials and Methods. Patients: Retrospective analysis of 50 children who underwent femoral lengthening. One group included patients who were treated with PRECICE lengthening nails, the other group included patients who had lengthening with external fixation. Each group included 25 patients aged between 11–17 years. The patients in both groups were matched for age. Cost analysis was performed following micro-costing and analysis of the used resources during the different phases of the treatments. Results. : Each group's mean patient age was 14.7 years. Lengthening nails were associated with longer operative times compared to external fixators, both for implantation and removal surgery (P-value 0.007 and <0.0001 respectively). Length of stay following the implantation surgery, frequency of radiographs, frequency of outpatient department appointments were all more favourable with lengthening nails. The overall cost of lengthening nails was £1393 more than external fixators, although this difference was not statistically significant (P-value 0.088). Conclusions. The cost of femoral lengthening with lengthening nails was not significantly higher than the external fixators’ cost. Further research to review the effectiveness of the devices and the quality of life during the lengthening process is crucial for robust health economic evaluation

Introduction. The purpose of this research is to compare the quality of life in children during gradual deformity correction using external fixators with intramedullary lengthening nails. Materials and Methods. Prospective analysis of children during lower limb lengthening. Group A included children who had external fixation, patients in group B had lengthening nails. Patients in each group were followed up during their limb reconstruction. CHU-9D and EQ-5DY instruments were used to measure quality of life at fixed intervals. The first assessment was during the distraction phase (1 month postop.), the second was during the early consolidation phase (3 months postop.) and the final one was late consolidation phase (6–9 months depends on the frame time). Results. Group B patients reported significantly better utility compared to Group A. This was observed during all the stages of the treatment. Group B children were less worried (P 0.004), less sad (P 0.0001), less pain (p <0.0001), less tired (P 0.0002), better school work (P0.0041), better sleep (p 0.016), more able to do sports activities (p 0.004) and, they were more independent (p <0.0001) compared to group B. QALYS was better for the nails group compared to external fixation group 0.44 compared to 0.36 for external fixators. Conclusions. Lengthening nails had the potential to improve the quality of life and utility compared to external fixation. This will help further economic evaluation to measure ICER to further explore the cost effectiveness of these devices

Introduction: The aim of the study is to assess the complication rate in lengthening of the femur and to analyze the main factors inducing complications. Materials & method: A retrospective study of 151 cases of lengthening with different methods (External Fixator of Judet 9, Callotasy with Orthofix :89, Ilizarov 9, External Fixator of Wagner 9, Lengthening Albizzia Nail 29) was investigated. The mean age was 13, 21 years (ET : 4,82, max : 38, min : 4). The aetiologies of femoral length discrepancy were congenital in 85 cases, post traumatic in 30, Post infectious in 22 and neurologic in 13 cases. One girl had Still’s Disease. The mean elongation was 55,17mm (ET : 17,3, Max ; 130, min : 20) except with the Ilizarov method with a mean lengthening of 91,8 mm. The mean percentage of elongation was 21 %. Classification of the Complications was in three grades :. - I : Benign complication without any unexpected surgery or anaesthesia. - II : Serious complication with unexpected surgery or anaesthesia. - III : Severe complication. The complications were recorded in four periods: surgery, elongation, consolidation and late complications. Results: There were 151 complications (78 Grade I, 59 grade III, 14 grade III). There were only three complications during first surgical procedure, 95 during elongation 49 during consolidation and 4 late complications. Analysis of the different pathologies shows that the rate of complications is the same for each etiology (around 100%) but the rate of complications of grade 2 and 3 shows a significant difference with a higher rate for neurological and congenital aetiologies. Benign complications are found in the post infection group. Analysis of the different methods used shows the same rate of complications in benign conditions except for the Albizzia Nail with a significant lower rate. Complications of grade 2 are seen in the ancient Judet method and in the Albizzia Nail due to the multiple general anaesthesia . Complications of grade 3 are seen in the Wagner method due to a high rate of congenital pathology and to a mean lengthening of 35 % of femoral initial length. Articular complications do not show any significant difference between the different methods. The main complications are seen in neurological and post infectious diseases. The mean percentage of lengthening in these complications is not different of the mean percentage of the series. Conclusion: Lengthening of the femur is still a difficult problem with a mean rate of complications of 100 % The type of method used is not the main determinant in the appearance of these complications. We want to emphazise the difficulties in performing lengthenings in neurological and congenital pathologies

Aims

To systematically review the outcomes and complications of cosmetic stature lengthening.

The June 2014 Children’s orthopaedics Roundup³⁶⁰ looks at: plaster wedging in paediatric forearm fractures; the medial approach for DDH; Ponseti – but not as he knew it?; Salter osteotomy more accurate than Pemberton in DDH; is the open paediatric fracture an emergency?; bang up-to-date with femoral external fixation; indomethacin, heterotopic ossification and cerebral palsy hips; lengthening nails for congenital femoral deformities, and is MRI the answer to imaging of the physis?