Femoral lengthening: callotasis with Ilizarov external fixator alone and with intramedullary locking nail

Callus distraction (callotasis) has improved the results of limb lengthening and has decreased complication rates. Unfortunately, this technique requires a long time in an external fixator device to allow bone regeneration and consolidation, especially in adults. We retrospectively compared the results and complications of two groups of patients who underwent femoral lengthening by means of callotasis with the Ilizarov external fixator. Group I underwent callotasis alone, and group II underwent callotasis with an intramedullary locking nail. Group I consisted of 14 patients, with a median age at surgery of 24.3 years. Group I etiologies were trauma in seven patients, congenital disorders in four and sequelae of poliomyelitis in three. Group II consisted of seven patients, with a median age at surgery of 22.4 years. The etiologies in group II were trauma in five patients and congenital disorders in two. In group I, the median gain in length was 4 cm. The median time in the external fixator was 218 days. The median time index of external fixation was 50 days/cm. Complications included four pin tract infections, one incomplete corticotomy, one refracture and one flexion contracture after removal of the external fixator. In group II, the median gain in length was 4.8 cm, and the median time in the external fixator was 70 days. The median time index of external fixation was 14 days/cm. There were no major complications except one distal screw backout, which did not impair the final outcome. We conclude that femoral lengthening by callotasis with combined Ilizarov external fixator and intramedullary locking nail can significantly shorten the treatment in the external fixator period, with good results and low complication rates in adults.