Tibial lengthening over an intramedullary nail

Area of Science:

• Orthopedic surgery
• Biomechanical engineering
• Regenerative medicine

Background:

• External fixators for leg lengthening can cause pin-tract infections and joint stiffness.
• Prolonged external fixator use significantly impacts daily living activities.
• A novel approach combines intramedullary nailing with external fixation to mitigate these issues.

Purpose of the Study:

• To evaluate the efficacy and safety of combined intramedullary nailing and external fixation for tibial lengthening.
• To compare this combined technique against standard external fixation alone.
• To assess complication rates, fixation duration, and bone consolidation.

Main Methods:

• A retrospective comparison of 13 tibias (8 patients) using combined intramedullary nailing and external fixation versus 17 tibias (16 patients) with external fixation alone.
• Exclusion criteria included prior bone infection, open fractures, immature bone, and severe deformities.
• Key metrics included external fixation index, consolidation index, operating time, blood loss, and complication rates.

Main Results:

• The combined group showed a significantly lower external fixation index but a similar consolidation index compared to the control group.
• Operating time increased by approximately 60 minutes for the combined technique, with no increase in blood loss.
• Complications related to the external fixator were substantially reduced in the combined group, with satisfactory callus formation observed in both.

Conclusions:

• Combined intramedullary nailing and external fixation provide bone healing comparable to the Ilizarov method.
• This technique effectively reduces the duration of external fixation.
• The combined approach leads to a significant decrease in external fixator-related complications.