Trochanteric Entry for Femoral Lengthening Nails in Children: Is It Safe?

Hammouda, Ahmed I.; Jauregui, Julio J.; Gesheff, Martin G.; Standard, Shawn C.; Herzenberg, John E.

doi:10.1097/bpo.0000000000000636

Cited by 48 publications

(40 citation statements)

References 22 publications

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“…The one patient with knee pain postoperatively reported great improvement in the pain compared to before the surgery. No cases of avascular necrosis occurred, confirming previous findings regarding the safety of femoral lengthening via a trochanteric entry in children [23].…”

Section: Discussionsupporting

confidence: 88%

Combined antegrade femur lengthening and distal deformity correction: a case series

Jardaly

Gilbert

2021

J Orthop Surg Res

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Background Leg length discrepancy is often associated with distal femur angular deformities such as valgus or flexion. This study aims to report a new technique for simultaneous limb lengthening and acute distal femoral angular correction. Methods A retrospective chart review of patients undergoing a single procedure was conducted. Patients included had a single operation where they underwent distal femur osteotomy stabilized with a plate followed by antegrade nailing with a magnetically controlled intramedullary lengthening nail (PRECICE, Ellipse Technologies, Inc., Irvine, CA, USA) using a trochanteric entry. Results Seven femurs from 7 patients were included. The average age at operation was 13.6 years, and the leg length difference was 51 mm (range 30–105 mm). Associated deformities were valgus (4), knee flexion contracture (2), and both valgus and flexion contracture (1). Lengthening achieved was 43 mm (P = 0.0036), with a consolidation index of 27 days/cm and reliability of 0.87 (6/7). The 5 patients with angulation had an improvement of valgus from 12 to 4° (P = 0.006) and of the mechanical axis deviation from 34 to 3 mm (P = 0.0001). The range of motion also improved in the 3 patients with contractures. Preoperative gait disturbance, hip and knee pain, and functional scoliosis resolved after the limb deformities were corrected. Conclusion Combining a magnetic internal lengthening nail with a second distal osteotomy stabilized with a plate can successfully correct limb length and distal femur deformity acutely without altering the expected result of each procedure.

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Section: Discussionsupporting

confidence: 88%

Combined antegrade femur lengthening and distal deformity correction: a case series

Jardaly

Gilbert

2021

J Orthop Surg Res

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“…2016, Hammouda et al. 2017). Trochanteric entry can be used in femoral nailing in the skeletally immature patient (MacNeil et al.…”

Section: Discussionmentioning

confidence: 99%

Limb lengthening and deformity correction with externally controlled motorized intramedullary nails: evaluation of 50 consecutive lengthenings

et al. 2018

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Background and purpose — Limb lengthening with an intramedullary motorized nail is a relatively new method. We investigated if lengthening nails are reliable constructs for limb lengthening and deformity correction in the femur and the tibia.Patients and methods — 50 lengthenings (34 Precice and 16 Fitbone devices) in 47 patients (mean age 23 years [11–61]) with ≥12 months follow-up are included in this study. 30 lengthenings were done due to congenital and 20 because of posttraumatic deformity (21 antegrade femora, 23 retrograde femora, 6 tibiae). Initial deformities included a mean shortening of 42 mm (25–90). In 15 patients, simultaneous axial correction was done using the retrograde nailing technique.Results — The planned amount of lengthening was achieved in all but 2 patients. 5 patients who underwent simultaneous axial correction showed minor residual deformity; unintentionally induced minor deformities were found in the frontal and sagittal plane. The consolidation index was 1.2 months/cm (0.6–2.5) in the femur and 2.5 months/cm (1.6–4.0) in the tibia. 2 femoral fractures occurred in retrograde femoral lengthenings after consolidation due to substantial trauma. There were 8 complications, all of which were correctable by surgery, with no permanent sequelae.Interpretation — Controlled acute axial correction of angular deformities and limb lengthening can be achieved by a motorized intramedullary nail. A thorough preoperative planning and intraoperative control of alignment are required to avoid residual and unintentionally induced deformity. In the femur relatively fast consolidation could be observed, whereas healing was slower in the tibia.

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“… 14 – 16 Hammouda et al have investigated the insertion of an antegrade femoral nail through the greater trochanter in children and did not detect complications in this approach. 17 The antegrade femoral nail can mainly achieve lengthening over the anatomical axis without mechanical axis correction. On contrary, it is possible to correct significant mechanical axis deformities of the femur by a distal femoral osteotomy and retrograde insertion of a lengthening nail.…”

Section: Introductionmentioning

confidence: 99%

Does Retrograde Femoral Nailing through a Normal Physis Impair Growth? An Experimental Porcine Model

Abood¹,

Rahbek²,

Olesen³

et al. 2021

Strategies in Trauma and Limb Reconstruction

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A bstract Materials and methods The study was carried out using an experimental porcine model. Eleven juvenile female porcines were randomized for insertion of a retrograde femoral nail in one limb. The other limb acted as a control. The animals were housed for 8 weeks before the nail was removed and housed for 8 additional weeks, that is, 16 weeks in total. Growth was assessed by interphyseal distance on 3D magnetic resonance imaging (MRI) after 16 weeks and the operated limb was compared to the non-operated limb. Histomorphometric analysis of the physeal canal was performed. Results No difference in longitudinal growth was observed when comparing the operated femur to the non-operated femur using MRI after 16 weeks. No osseous tissue crossing the physis was observed on MRI or histology. The empty canal in the physis after nail removal was filled with fibrous tissue 16 weeks after primary surgery. Conclusion Growth was not impaired and no bone bridges were seen on MRI or histology 16 weeks after insertion and later removal of the retrograde femoral nail. Clinical significance The insertion of a retrograde intramedullary femoral nail centrally through the physis and later removal might be safe, however, long-term follow-up is needed. Aim and objective The insertion of an intramedullary nail may be beneficial in certain cases of leg length discrepancy (LLD) in children. However, it is unknown if the physeal injury due to the surgery may cause bone bridge formation and thereby growth arrest after removal. This study aimed to assess longitudinal interphyseal growth 16 weeks after insertion and later removal of a retrograde femoral nail passing through the physis. Moreover, to analyse the tissue forming in the empty physeal canal after removal of the nail. How to cite this article Abood AA, Rahbek O, Olesen ML, et al . Does Retrograde Femoral Nailing through a Normal Physis Impair Growth? An Experimental Porcine Model. Strategies Trauma Limb Reconstr 2021;16(1):8–13.

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Trochanteric Entry for Femoral Lengthening Nails in Children: Is It Safe?

Abstract: Level IV-therapeutic.

Cited by 48 publications

References 22 publications

Combined antegrade femur lengthening and distal deformity correction: a case series

Combined antegrade femur lengthening and distal deformity correction: a case series

Limb lengthening and deformity correction with externally controlled motorized intramedullary nails: evaluation of 50 consecutive lengthenings

Does Retrograde Femoral Nailing through a Normal Physis Impair Growth? An Experimental Porcine Model

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