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

Aims

Double-level lengthening, bone transport, and bifocal compression-distraction are commonly undertaken using Ilizarov or other fixators. We performed double-level fixator-assisted nailing, mainly for the correction of deformity and lengthening in the same segment, using a straight intramedullary nail to reduce the time in a fixator.

Aims

The Precice intramedullary limb-lengthening system has demonstrated significant benefits over external fixation lengthening methods, leading to a paradigm shift in limb lengthening. This study compares outcomes following antegrade and retrograde femoral lengthening in both adolescent and adult patients.

Femoral lengthening using the Intramedullary Skeletal Kinetic Distractor is a new technique. However, with intramedullary distraction the surgeon has less control over the lengthening process. Therefore, 33 femora lengthened with this device were assessed to evaluate the effect of operative variables under the surgeon’s control on the course of lengthening. The desired lengthening was achieved in 32 of 33 limbs. Problems encountered included difficulty in achieving length in eight femora (24%) and uncontrolled lengthening in seven (21%). Uncontrolled lengthening was more likely if the osteotomy was placed with less than 80 mm of the thick portion of the nail in the distal fragment (p = 0.052), and a failure to lengthen was more likely if there was over 125 mm in the distal fragment (p = 0.008). The latter problem was reduced with over-reaming by 2.5 mm to 3 mm. Previous intramedullary nailing also predisposed to uncontrolled lengthening (p = 0.042), and these patients required less reaming.

Using the Intramedullary Skeletal Kinetic Distractor, good outcomes were obtained; problems were minimised by optimising the position of the osteotomy and the amount of over-reaming performed.

We present a retrospective review of a single-surgeon series of 30 consecutive lengthenings in 27 patients with congenital short femur using the Ilizarov technique performed between 1994 and 2005.

The mean increase in length was 5.8 cm/18.65% (3.3 to 10.4, 9.7% to 48.8%), with a mean time in the frame of 223 days (75 to 363). By changing from a distal to a proximal osteotomy for lengthening, the mean range of knee movement was significantly increased from 98.1° to 124.2° (p = 0.041) and there was a trend towards a reduced requirement for quadricepsplasty, although this was not statistically significant (p = 0.07). The overall incidence of regenerate deformation or fracture requiring open reduction and internal fixation was similar in the distal and proximal osteotomy groups (56.7% and 53.8%, respectively). However, in the proximal osteotomy group, pre-placement of a Rush nail reduced this rate from 100% without a nail to 0% with a nail (p < 0.001). When comparing a distal osteotomy with a proximal one over a Rush nail for lengthening, there was a significant decrease in fracture rate from 58.8% to 0% (p = 0.043).

We recommend that in this group of patients lengthening of the femur with an Ilizarov construct be carried out through a proximal osteotomy over a Rush nail. Lengthening should also be limited to a maximum of 6 cm during one treatment, or 20% of the original length of the femur, in order to reduce the risk of complications.