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. 2011 Jun;82(3):344-50.
doi: 10.3109/17453674.2011.584209. Epub 2011 May 11.

Intramedullary leg lengthening with a motorized nail

Andreas H Krieg  1 , Ulrich Lenze, Bernhard M Speth, Carol C Hasler
Affiliations

Intramedullary leg lengthening with a motorized nail

Andreas H Krieg et al. Acta Orthop. 2011 Jun.

Abstract

Background and purpose: In the last decade, intramedullary limb lengthening has become a viable alternative to traditional external systems. We retrospectively analyzed the use of an intramedullary motorized nail (Fitbone) in a consecutive series of 32 patients.

Patients and methods: During the period September 2006 to December 2008, 32 consecutive patients with a median age of 17 (IQR: 15-19) years were treated with a fully implantable, motorized intramedullary lengthening device (Fitbone). The median leg length discrepancy was 35 (IQR: 30-44) mm at the femur (n = 21) and 28 (IQR: 25-30) mm at the tibia (n = 11).

Results: Leg lengthening was successful in 30 of 32 cases, with no residual relevant discrepancy (± 5 mm). No intraoperative complications were observed. The consolidation index was significantly different (p = 0.04) between femoral lengthening (mean 35 days/cm) and tibial lengthening (mean 48 days/cm) but did not depend on age older/younger than 16 or previous operations at the affected site. 3 problems, 3 obstacles, and 4 complications (3 minor, 1 major) were encountered in 8 patients, 5 of which were implant-associated.

Interpretation: This technique even allows correction in patients with multiplanar deformities. Compared to external devices, intramedullary systems provide comfort and reduce complication rates, give improved cosmetic results, and lead to fast rehabilitation since percutaneous, transmuscular fixation is prevented. This results in reasonable overall treatment costs despite the relatively high costs of implants.

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Figures

Figure 1.
Figure 1.
Fitbone TAA (Telescope Active Actuator) and SAA (Sliding Active Actuator) with control and transmitter unit.
Figure 2.
Figure 2.
Overview of the different indices.
Figure 3.
Figure 3.
Range of motion 4 months postoperatively, after 5.5 cm of lengthening of the tibia.
Figure 4.
Figure 4.
Frontal plane double deformity of the tibia with LLD of 5.5 cm in a patient with a history of osteomyelitis in early childhood and of previous operations.
Figure 5.
Figure 5.
Anteroposterior and lateral radiographs 3 months (left) and 9 months (right) after surgery.
See this image and copyright information in PMC

References

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