Tibial lengthening: technique for speedy lengthening by external fixation and secondary internal fixation

The conventional Ilizarov technique for tibial lengthening is frequently time-consuming, causes suffering, and is associated with many complications. This study takes a retrospective approach to investigate the outcome of applying a slightly speedier procedure using an Ilizarov apparatus and secondary internal fixation.

Twelve adult patients displaying tibial shortening (median, 4.0 cm; mean, 4.6 cm; range, 3.0-12.0 cm) with various causes were treated with or without tibial osteotomy and stabilized using an Ilizarov lengthening apparatus. Postoperatively, lengthening of 1 to 1.5 mm/day was performed until the desired length was achieved. External fixation was then converted to internal fixation and either pure autogenous bone graft, or a mixture of autogenous and allogenous bone graft was supplemented. Postoperatively, protected weight bearing was advised until bony union was achieved.

Eleven patients were followed up for a median of 3.4 years (mean, 4.0 years; range, 2.1-6.7 years) and solid union was achieved in all cases. Median external fixation occurred after 1.8 months (mean, 1.9 months; range, 1.2-4.5 months) and the median time until union after internal fixation was 4.5 months (mean, 4.8 months; range, 4-6 months). Two patients with rigid equinus feet required concomitant Achillis tendon lengthening. No other significant complications were noted. Classification of the results revealed that improvement from an unsatisfactory to a satisfactory outcome was achieved in all patients (p < 0.001).

The described technique shortens the external fixation period and reduces patient suffering. Moreover, a high union rate and a low complication rate are achieved. Subjectively and objectively, patients can achieve satisfactory outcomes. Consequently, the described technique may be considered as an alternative to conventional techniques when indicated.