Tibial Lengthening with a Motorized Intramedullary Lengthening Nail.

Area of Science:

• Orthopedic surgery
• Limb reconstruction
• Biomechanical engineering

Background:

• Motorized intramedullary lengthening nails (MILN) enable precise distraction osteogenesis for tibial lengthening, avoiding external fixation.
• MILN is applicable to congenital and acquired etiologies of limb-length discrepancy (LLD), including short stature and post-traumatic cases.
• This video details the surgical technique for MILN application in skeletally mature patients using the Precice System.

Purpose of the Study:

• To describe the surgical technique for tibial lengthening using a motorized intramedullary lengthening nail (MILN).
• To illustrate the preoperative evaluation, surgical steps, and postoperative management for MILN procedures.
• To highlight the benefits of MILN in deformity correction and achieving bone lengthening.

Main Methods:

• Comprehensive preoperative assessment including history, physical examination, and radiographic evaluation for LLD and deformity.
• Surgical technique involves tibial osteotomy, canal reaming, MILN insertion, and fixation, with considerations for prophylactic fasciotomy and blocking screws.
• Postoperative lengthening protocol begins approximately 7 days after surgery, with gradual daily increments.

Main Results:

• MILN allows for precise deformity correction and bone lengthening up to 8 cm with a low complication rate when performed safely.
• Patients require adherence to weight-bearing restrictions and physical therapy to prevent joint stiffness and optimize outcomes.
• High patient satisfaction is generally reported following successful tibial lengthening with MILN.

Conclusions:

• MILN is a reliable method for tibial lengthening and deformity correction, offering an internal fixation solution.
• Meticulous surgical planning, technique, and patient compliance are crucial for successful outcomes and minimizing adverse events.
• Alternative lengthening methods exist, but MILN provides convenience and precision for selected LLD cases.