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Femoral Lengthening in Children: A Comparison of Motorized Intramedullary Nailing Versus External Fixation Techniques
Laura O Tillotson1, Connor L Maddock, Jacqueline Hanley
1Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Motorized intramedullary nails significantly reduce complications and hospital stays for pediatric femoral lengthening compared to external fixation devices. This advancement offers a safer, more efficient treatment option for children requiring limb lengthening procedures.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Biomedical engineering
Background:
- Femoral lengthening procedures carry high complication risks, often linked to the chosen surgical device.
- Intramedullary lengthening devices offer a potential solution to mitigate complications associated with external fixation systems.
Purpose of the Study:
- To compare clinical outcomes of pediatric femoral lengthening using a motorized intramedullary nail (Precice) versus external fixation (Taylor Spatial Frame or Monolateral Rail System).
Main Methods:
- Retrospective study of pediatric patients (ages 8-18) undergoing femoral lengthening between 2010-2019.
- Patients were grouped based on the device used: Precice nailing or external fixation (TSF/MRS).
- Comparison of complication rates, length of stay, and achievement of lengthening goals.
Main Results:
- The Precice group exhibited significantly lower complication rates (6.6%) compared to external fixation (47.1%, P<0.01).
- No significant differences were observed in the percentage of goal length achieved or total length achieved between groups.
- The Precice group experienced a significantly shorter length of stay (2.2 days) versus external fixation (3.7 days, P=0.01).
Conclusions:
- Motorized intramedullary nails (Precice) are associated with a markedly reduced rate of complications in pediatric femoral lengthening.
- This device also leads to a shorter hospital stay compared to traditional external fixation methods.
- Precice nailing represents a safer and more efficient option for pediatric femoral lengthening.
Background:
Femoral lengthening is associated with high complication rates often related to the type of surgical device used to perform the lengthening. The advent of intramedullary lengthening devices has promised a reduction in complications when compared with external fixation systems. The purpose of this study was to compare the clinical outcomes of femoral lengthening in children using a motorized intramedullary nail (Precice) versus an external fixation system (Taylor Spatial Frame-TSF; or Monolateral Rail System-MRS) at a single institution, single surgeon practice.
Methods:
This study is a retrospective comparison of pediatric patients who had previously undergone femoral lengthening (±deformity correction). Patients ages 8 to 18 years of age were included and grouped based on whether they had undergone Precice nailing or external fixation (TSF or MRS) between 2010 and 2019.
Results:
Twenty-seven patients (32 femurs) were included. Thirteen patients (15 femurs) had undergone Precice nailing and 14 patients (17 femurs) had undergone external fixation. The Precice group had significantly fewer problems, obstacles, and complications than the external fixation group, Precice 6.6%, 0%, 0%, respectively, and external fixation 47.1%, 29.4%, 0% respectively (P<0.01). Unplanned return to the operating room occurred in 4 cases, solely in the external fixation group. There were no differences in percentage of goal length achieved, Precice (mean 93.6%, range: 66.7% to 114.3%), external fixation (mean 96%, range: 76.9% to 117.5%) P=0.31 and total length achieved, Precice (mean: 44 mm, range: 20 to 80 mm), external fixation (mean: 46 mm, range: 10 to 70 mm) P=0.72. There was no difference in consolidation index, Precice (24.1 d/cm), external fixation (28.5 d/cm) P=0.36. The Precice group had a significantly shorter length of stay (mean: 2.2 d, range: 1 to 4 d), compared with the external fixation group (mean: 3.7 d, range: 2 to 8), P=0.01.
Conclusions:
Femoral lengthening in children using a motorized intramedullary nail was associated with a markedly reduced rate of complications and shorter length of stay compared with external fixation.
Level Of Evidence:
Level III.
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