Tibial lengthening over an intramedullary nail in patients with short stature or leg-length discrepancy: a comparative study

Guo, Qianchen; Zhang, Tao; Zheng, Yiming; Feng, Shiqing; Ma, Xinlong; Zhao, Feng

doi:10.1007/s00264-011-1246-2

Cited by 46 publications

(36 citation statements)

References 16 publications

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“…However, the concomitant use of an intramedullary nail, such as with tibial LON, can act as a strong resistance to the deforming forces, minimizing axial deviations compared with the classic Ilizarov method. Some studies [2,3,15,20,21] compared the classic Ilizarov method with the LON technique and showed that axial deviation occurred in 4% to 13% of tibias with the classic Ilizarov method, whereas it was 0% to 2% with the LON technique. However, Kim et al [8] reported that they observed 20 segments (14%) that showed valgus angulation with a mean of 10°using the LON technique.…”

Section: Discussionmentioning

confidence: 99%

“…It can act as a guide such that the bone is lengthened along the longitudinal axis of the nail with no axial deviations. It was reported that the secondary deformity induced during distraction could be substantively negated with the intramedullary nail in the LON technique of the tibia [3,15,20,21]. However, Kim et al [8] reported that a valgus deviation was the most common complication in 20 segments (25%) in their series of the LON technique of the tibia.…”

Section: Introductionmentioning

confidence: 99%

“…Another potential advantage of this technique is that it prevents the secondary deformity that can occur during distraction [3,15,20,21]. In contrast to the classic Ilizarov method, the intramedullary nail in the LON technique is thought to resist distraction-resisting deforming forces [14,20].…”

Section: Introductionmentioning

confidence: 99%

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Is there an Increase in Valgus Deviation in Tibial Distraction Using the Lengthening Over Nail Technique?

Park

Ryu

Kim

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background During tibial lengthening, the soft tissues of the posterolateral compartment produce distraction-resisting forces causing valgus angulation. Although this occurs with the classic Ilizarov method, whether a valgus deformity develops with the lengthening over nail (LON) technique is questioned, because the intramedullary nail is thought to resist deforming forces and adequately maintain alignment of the distracted bone. Questions/purposes The purposes of this study were to (1) determine the amount of valgus deviation during tibial lengthening with the LON technique; and (2) analyze the factors that may be associated with valgus deviation with the LON technique. Methods Between June 2009 and September 2013, we performed 346 tibial lengthenings using the LON technique, lengthening and then nail technique, or lengthening with an intramedullary lengthening device. Sixty patients (120 tibias) who underwent bilateral lower leg lengthening with the LON technique were enrolled in this retrospective study. To limit the number of variables, we analyzed only the right tibia in all patients (60 tibias). The mean followup was 42 months (range, 26-71 months). The mean age of the patients was 25 years (range, 18-40 years). There were 36 male and 24 female patients. The mean final length gain was 67 ± 9 mm. The mean time for distraction was 100 ± 25 days. The overall valgus deviation was assessed by measuring the change in the medial proximal tibial angle and mechanical femorotibial angle on radiographs obtained before and after surgery and after completion of lengthening. Several demographic, surgical, and distraction-related variables were considered possible factors to prevent valgus deviation: proximal fixation method; presence of a blocking screw; diameter and length of the intramedullary nail; degree of nail insertion; length of the nail in the distal segment after completion of distraction; final length gain; and patient's BMI. During the period studied, the blocking screw was to maintain the mechanical axis in patients who had neutral or valgus alignment preoperatively, or to prevent more valgus change in patients who underwent acute correction of varus deformity intraoperatively. Uni-and multivariate analyses were conducted. Results Valgus deviation occurred during the tibial LON. The medial proximal tibial angle increased from 86°(95% CI, 85°-86°) to 90°(95% CI, 89°-91°) (p \ 0.001). The mechanical femorotibial angle changed from 2.2°varus (95% CI, 3°-1.4°varus) to 2.6°valgus (95% CI, 1.8°-3.4°E

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Is there an Increase in Valgus Deviation in Tibial Distraction Using the Lengthening Over Nail Technique?

Park

Ryu

Kim

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…The combined techniques resulted in the reduction of the usual IEF duration and good union rates [3–5]. There were many clinical studies of using the external fixator over the nail or FIN for orthopaedic conditions and injuries [4, 5, 11, 12]. …”

Section: Discussionmentioning

confidence: 99%

Bone Healing by Using Ilizarov External Fixation Combined with Flexible Intramedullary Nailing versus Ilizarov External Fixation Alone in the Repair of Tibial Shaft Fractures: Experimental Study

Попков

Кононович

Горбач

et al. 2014

The Scientific World Journal

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Purpose. Our research was aimed at studying the radiographic and histological outcomes of using flexible intramedullary nailing (FIN) combined with Ilizarov external fixation (IEF) versus Ilizarov external fixation alone on a canine model of an open tibial shaft fracture. Materials and Methods. Transverse diaphyseal tibial fractures were modelled in twenty dogs. Fractures in the dogs of group 1 (n = 10) were stabilized with the Ilizarov apparatus while it was combined with FIN in group 2 (n = 10). Results. On day 14, a bone tissue envelope started developing round the FIN wires. Histologically, we revealed only endosteal bone union in group 1 while in group 2 the radiographs revealed complete bone union on day 28. At the same time-point, the areas of cancellous and mature lamellar bone tissues were observed in the intermediary area in group 2. The periosteal layers were formed of the trabeculae net of lamellar structure and united the bone fragments. The frame was removed at 30 days after the fracture in group 2 and after 45 days in group 1 according to bone regeneration. Conclusion. The combination of the Ilizarov apparatus and FIN accelerates bone repair and augments stabilization of tibial shaft fractures as compared with the use of the Ilizarov fixation alone.

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“…They are reported after failed total knee arthroplasty (TKA), severe post-traumatic osteoarthritis in young patients, reconstruction after tumor resection, chronic sepsis and totally destroyed knee joints after severe trauma [1][2][3]. Using this technique the intramedullary nail prevents bending, refracture [4][5][6][7], subsidence [8], bowing of the regenerate bone and secondary shortening. Furthermore the time in an external frame is shortened and improves patient´s comfort and life quality during the healing phase [9].…”

Section: Introductionmentioning

confidence: 99%

Knee Arthrodesis in Severe Injured Knee Joints

Žák¹,

Tiefenboeck²,

Wozasek³

2016

J Trauma Treat

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In this report we present our experiences with knee arthrodesis nails as a secondary salvage procedure after severe knee injuries at a level-one trauma centre. Exemplary two cases of subtotal amputation are discussed. Both cases, of totally destroyed knee joints, were treated with a unilateral external fixator, shortening and secondary bifocal distraction osteogenesis. In one case nailing after lengthening (NAL) was performed and in the second case nailing had to be performed as fracture treatment 20 years after bony consolidation at the docking site.

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Tibial lengthening over an intramedullary nail in patients with short stature or leg-length discrepancy: a comparative study

Cited by 46 publications

References 16 publications

Is there an Increase in Valgus Deviation in Tibial Distraction Using the Lengthening Over Nail Technique?

Is there an Increase in Valgus Deviation in Tibial Distraction Using the Lengthening Over Nail Technique?

Bone Healing by Using Ilizarov External Fixation Combined with Flexible Intramedullary Nailing versus Ilizarov External Fixation Alone in the Repair of Tibial Shaft Fractures: Experimental Study

Knee Arthrodesis in Severe Injured Knee Joints

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