Tibial lengthening using a reamed type intramedullary nail and an Ilizarov external fixator

Abstract

The aim of this study was to evaluate the efficacy of tibial lengthening using a reamed type intramedullary nail and an Ilizarov external fixator for the treatment of leg length discrepancy or short stature. This retrospective study was performed on 18 tibiae (13 patients) in which attempts were made to reduce complications. We used an Ilizarov external fixator and a nail (10 mm diameter in 17 tibiae and 11 mm in one tibia) in combination. Average limb lengthening was 4.19 cm (range, 2.5-5.5). The mean duration of external fixation was 12.58 days per centimetre gain in length, and the mean consolidation index was 40.53 (range, 35.45-51.85). All distracted segments healed spontaneously without refracture or malalignment. Gradual limb lengthening using a reamed type intramedullary nail and circular external fixation in combination was found to be reliable and effective and reduced external fixation time with fewer complications.

Experimental study of progressive tibial lengthening in dogs using the Ilizarov technique. Comparison with and without associated intramedullary K-wires

“…The HI corresponds to the ratio of the number of days an EF is in place compared to the amount of lengthening measured in centimeters [5]. This is reduced by very regular lengthening of 1 mm per day distributed over 60 days using automatic distraction osteosynthesis [6][7][8], by multifocal and/or multisegmental lengthening [9], or by adding intramedullary implants such as nails [10][11][12][13][14][15][16][17] or elastic stable intramedullary nailing (ESIN) [18][19][20][21]. This association of intramedullary implants with EFs has made it possible to lower the rate of deformities and fractures after removal of the EF.…”

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

“…Moreover, if the external fixator is removed too early, it may result in axial deviation or refracture. Since Paley et al first described it in 1997 [4], the surgical technique of lengthening over an intramedullary (IM) nail has gained wide acceptance because it reduces the duration required for external fixation and offers considerable improvements in patients' comfort [5]. However, Watanabe et al have reported that they encountered such a high rate of serious complications in patients treated with lengthening over an IM nail, including cases of deep infection and breakage of nails or locking screws, that they abandoned this technique and returned to the classic Ilizarov method [6].…”

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

“…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]. …”