Article
Treatment of skelettaly immature patients with motorized intramedullary lengthening nails
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Published: | October 22, 2019 |
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Objectives: Limb lengthening with motorized intramedullary lengthening nails is a well-established method in the treatment of adults. In contrast to external fixators, intramedullary lengthening nails provide a more comfortable and equally safe treatment. The applications of intramedullary lengthening nails for skeletally immature patients remains a challenge due to the patient's anatomy and growth considerations. Our goal is to further elucidate the indications and limitations when performing femoral and tibial lengthening procedures in children and adolescent patients.
Methods: A retrospective review (2016-2018) was performed to identify skeletally immature patients who underwent limb lengthening with motorized intramedullary nails in either an antegrad/retrograde femoral or antegrade tibial approach (Figure 1 [Fig. 1]).
Results and conclusion: On a total of 54 patients 60 procedures were performed. Three different types of nailing approaches where used: antegrade femoral (n=42), retrograde femoral (n=10), and antegrade tibial (n=8). Mean age at the time of surgery was 13.8 years. The average length of callus distraction was 45mm. In 58/60 cases (96.7%) the desired amount of lengthening was achieved, while two patients experienced complications that required interruption of the treatment. None of the patients developed complications associated to the nailing approach. Different approaches for intramedullary lengthening nails can be used in children and adolescents to correct leg length discrepancy with or without concomitant deformities. The treatment is limited by the size of the available nails, the residual growth and characteristics of the deformity. Larger trials will be needed to further validate the application of lengthening nails in skeletally immature patients.