Comparison of Intramedullary Nail Versus Conventional Ilizarov Method for Lower Limb Lengthening: A Systematic Review and Meta-Analysis

Abstract

The objective of this systematic review and meta-analysis was to compare the lengthening and then nailing (LATN) technique to the conventional Ilizarov method for limb lengthening. A systemic search of potential relevant literature was performed in databases, including the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, and the ISI Web of Knowledge, from their inception to 22 May 2015 using medical subject heading (MeSH) terms "Ilizarov," "bone lengthening," or "intramedullary nail." A total of 89 titles and abstracts were preliminarily reviewed, of which 4 studies eventually satisfied the eligibility criteria, consisting of one randomized controlled trial (RCT), two clinical controlled trials and one retrospective cohort study. A total of 354 limbs were included in the study, among which 183 were lengthened over an intramedullary nail, and 171 limbs were lengthened conventionally. The mean difference (MD) was -50.21 for the external fixation index between the two groups (95% CI, -51.83 to -48.59; P < 0.00001) with high heterogeneity (I² = 99%); no significant difference in length was gained (MD = -0.30, 95% CI = -0.72 to 0.12; P = 0.16) with high heterogeneity (I² = 80%); and there was high significant difference for the consolidation index (MD = -19.97; 95% CI, -21.59 to -18.35; P < 0.00001) with high heterogeneity (I² = 100%). The overall rate of complications was relatively low, and differed significantly between the two groups. Through this meta-analysis, we find that LATN is superior to the conventional method in regards to the external fixation index and the consolidation index, which means that LATN is an effective technique that can decrease the time needed in external fixation.

Keywords: Ilizarov; Intramedullary nail; Lower limbs lengthening; Meta analysis.

Figure 1

Flow chart of literature searching procedure.

Figure 2

Methodological quality of the randomized controlled trials. +, low risk of bias; ?, unclear risk of bias; high risk of bias.

Figure 3

Forest plot diagram illustrating external fixation index in comparison between lengthening and then nailing (LATN) and conventional methods. CI, confidence interval; RCT, randomized controlled trial; SD, standard deviation.

Figure 4

Forest plot diagram illustrating length gained in comparison between lengthening and then nailing (LATN) and conventional methods. CI, confidence interval; RCT, randomized controlled trial; SD, standard deviation.

Figure 5

Forest plot diagram illustrating consolidation index in comparison between lengthening and then nailing (LATN) and conventional methods. CI, confidence interval; RCT, randomized controlled trial; SD, standard deviation.

Figure 6

Forest plot diagram illustrating pin tract infection in comparison between lengthening and then nailing (LATN) and conventional methods. CI, confidence interval; RCT, randomized controlled trial; SD, standard deviation.

Figure 7

Forest plot diagram illustrating intramedullary infection in comparison between lengthening and then nailing (LATN) and conventional methods. CI, confidence interval; RCT, randomized controlled trial; SD, standard deviation.

Figure 8

Forest plot diagram illustrating refracture in comparison between lengthening and then nailing (LATN) and conventional methods. CI, confidence interval; RCT, randomized controlled trial; SD, standard deviation.

Figure 9

Forest plot diagram illustrating axial deviation in comparison between lengthening and then nailing (LATN) and conventional methods. CI, confidence interval; RCT, randomized controlled trial; SD, standard deviation.

Figure 10

Forest plot diagram illustrating joint contracture in comparison between lengthening and then nailing (LATN) and conventional methods.