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Sequential Limb Lengthening: A Novel Staged Approach Combining External Fixation and a Motorized Intramedullary
T Cerasoli1, G Balboni1, C Musiani2
1Department of Biomedical and Neuromotor Sciences DIBINEM, Alma Mater Studiorum University of Bologna, Bologna, Italy, unibo.it.
Background:
Managing large posttraumatic tibial defects presents significant challenges. External fixation is effective for distraction osteogenesis but has drawbacks, including prolonged treatment time and complications. Intramedullary lengthening nails improve patient comfort but have limitations in large bone transport. While combined techniques have been explored, to our knowledge a fully sequential approach where an external fixator is first used for distraction and then replaced by a motorized intramedullary lengthening nail continuing the lengthening has not been clearly described in the literature. This study presents a novel staged technique and a review of existing literature on limb lengthening strategies.
Methods:
We report the case of a 29-year-old male with a 16-cm posttraumatic tibial defect, treated with 10 cm of bone transport using an external fixator, followed by 6 cm of additional lengthening with a motorized intramedullary nail. Additionally, a literature search was conducted in PubMed, Scopus, and Embase using keywords related to limb lengthening, external fixation, and intramedullary nailing. The technique and outcomes were compared with existing literature.
Discussion:
The review did not identify any studies on fully sequential limb lengthening. Most studies focus on pediatric cases or hybrid techniques where external fixation and intramedullary nailing are used simultaneously. Our sequential approach allowed for controlled distraction and successfully addressed a 16-cm bone defect.
Conclusions:
This case highlights a previously undescribed staged limb lengthening approach. Sequential conversion from external fixation to a motorized intramedullary lengthening nail may offer advantages in reducing EFI, protecting neurovascular structures, and enhancing mechanical stability. Further research is needed to evaluate long-term outcomes.
