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Complications in leg lengthening using an Ilizarov external fixator and intramedullary alignment in children:
Bojan Bukva1, Goran Vrgoč2, Ivan Rakovac3
1Department of Paediatric Orthopaedic Surgery, University Children's Hospital, Belgrade, Serbia.
Insights
Intramedullary alignment (IA) combined with the Ilizarov external fixator (IEF) reduces complications and hospital stays for pediatric leg lengthening. Titanium Elastic Nails (TEN) for IA show particular benefits in managing leg length discrepancies.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Limb reconstruction
Background:
- Leg lengthening procedures are crucial for correcting limb length discrepancies in children.
- The Ilizarov external fixator (IEF) is a common method for leg lengthening.
- Complications associated with IEF treatment necessitate evaluation of alternative or adjunctive techniques.
Purpose of the Study:
- To evaluate complications of leg lengthening using the Ilizarov external fixator (IEF).
- To compare complication rates between IEF alone and IEF with intramedullary alignment (IA).
- To assess the impact of IA type (Kirschner wires vs. Titanium Elastic Nails) on outcomes.
Main Methods:
- Retrospective study of 73 pediatric patients undergoing leg lengthening (2000-2014).
- Patients divided into two groups: IEF alone (n=39) and IEF with IA (n=34).
- IA utilized Kirschner wires (K-wires) or Titanium Elastic Nails (TEN); complications classified by Caton criteria.
Main Results:
- A high complication rate was observed with IEF alone compared to IEF with IA, though not statistically significant.
- A statistically significant difference in initial hospitalization duration was found, especially with TEN usage.
- No significant difference in complication rates or hospitalization duration between K-wire and TEN based IA.
Conclusions:
- Intramedullary alignment (IA) offers advantages in treating leg length inequality.
- Combining IA with a circular IEF significantly reduces complication rates and initial hospitalization duration.
- Titanium Elastic Nails (TEN) as an IA method show particular promise, potentially decreasing overall treatment costs.
Background:
The purpose of this retrospective study was to evaluate the complications associated with leg lengthening in children treated with the Ilizarov external fixator (IEF) and compare them between two groups of patients: one group was treated using an IEF alone and the other group was treated using an IEF in association with intramedullary alignment (IA).
Patients And Methods:
The study was performed at the University Children's Hospital in Belgrade, Serbia during a fourteen-year period (from 2000 to 2014). Complications occurred in 73 paediatric patients who underwent the leg lengthening procedure. Complications were classified according to the Caton classification and compared between two groups. Group I comprised 39 patients who underwent the limb lengthening procedure using IEF alone. Group II consisted of 34 patients who were treated with the combination of IEF and IA using two Kirschner wires (K-wires) or Titanium Elastic Nails (TEN). The duration of hospital treatment was also compared between the two groups and the impact of the type of IA on the occurrence of complications was assessed.
Results:
There was a high rate of complications in patients treated using an IEF compared with those treated using the combination of IEF and IA, but there was no statistically significant difference between the two groups. There was a statistically significant difference in the duration of initial hospitalisation between the two groups, particularly when comparing TEN usage in IA. A comparison of the group of patients treated using an IEF in association with K-wires and patients treated using IEF and TEN showed there was no statistically significant difference in complication rate and duration of initial hospitalisation.
Conclusion:
IA has multiple advantages as a method of treatment of leg length inequality. The major effect of applying IA in association with a circular IEF is significantly reduced complication rate and duration of initial hospitalisation, particularly when using TEN as a method of IA. This method of treatment also decreases hospital costs.
