Abstract
Introduction
Limb lengthening by external fixators is associated with many problems such as pain at the pin tracts, muscle transfixation, pin tract infections, reduced joint motion, and prolonged fixation time. The intramedullary skeletal kinetic distractor (ISKD) is a new internal, mechanically activated implant, which distracts by mild rotations of 3°.
Material and methods
In a prospective clinical study, four patients with an mean age of 29 years (18–36 years) underwent intramedullary lengthening via ISKD. The average lengthening of three femora and one tibia was 31 mm (26–40 mm).
Results
All patients performed the rotations for the distraction themselves without any significant problems. One patient took mild analgesics during the first days of distraction, whereas three patients did not require any analgesics. The average patient discharge occurred 10 days (8–11 days) postoperatively with no complications during the hospital stay. The planned length of distraction was achieved in all patients with normal alignment and normal joint orientation. Full weight bearing was performed on average after 10 weeks (7–14 weeks). Consolidation was noted 80 days (51–111 days) postoperatively with an average consolidation index of 2.9 days/mm. No complications were observed during the follow-up period of 14 months. The Enneking score was 26.8 points, and according to the classification of Paley all patients had an excellent result.
Conclusions
From these preliminary results we conclude that the comfort of limb lengthening with the ISKD is increased by the elimination of fixator-associated complications and by the simple distraction mechanism, which is well tolerated by the patients. Further advantages of the ISKD are early full weight bearing and excellent limb function.
Similar content being viewed by others
References
Aldegheri R (1999) Distraction osteogenesis for lengthening of the tibia in patients who have limb-length discrepancy or short stature. J Bone Joint Surg Am 81:624–634
Aronson J (1997) Limb-lengthening, skeletal reconstruction, and bone transport with the Ilizarov method. J Bone Joint Surg Am 79:1243–1258
Baumgart R, Betz A, Schweiberer L (1997) A fully implantable motorized intramedullary nail for limb lengthening and bone transport. Clin Orthop 343:135–143
Betz A, Baumgart R, Schweiberer L (1990) First fully implantable intramedullary system for callus distraction—intramedullary nail with programmable drive for leg lengthening and segment displacement. Principles and initial clinical results. Chirurg 61:605–609
Cole JD, Justin D, Kasparis T, DeVlught D, Knobloch C (2001) The intramedullary skeletal kinetic distractor (ISKD): first clinical results of a new intramedullary nail for lengthening of the femur and tibia. Injury 32 [Suppl 4]:129–139
Dahl MT, Gulli B, Berg T (1994) Complications of limb lengthening. A learning curve. Clin Orthop 301:10–18
Danziger MB, Kumar A, DeWeese J (1995) Fractures after femoral lengthening using the Ilizarov method. J Pediatr Orthop 15:220–223
Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ (1993) A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop 286:241–246
Faber FW, Keessen W, van Roermund PM (1991) Complications of leg lengthening. 46 procedures in 28 patients. Acta Orthop Scand 62:327–332
Garcia-Cimbrelo E, Curto A, Garcia-Rey E, Cordero J, Marti-Ciruelos R (2002) The intramedullary elongation nail for femoral lengthening. J Bone Joint Surg Br 84:971–977
Garcia-Cimbrelo E, Olsen B, Ruiz-Yague M, Fernandez-Baillo N, Munuera-Martinez L (1992) Ilizarov technique. Results and difficulties. Clin Orthop 283:116–123
Guichet JM, Casar RS (1997) Mechanical characterization of a totally intramedullary gradual elongation nail. Clin Orthop 337:281–290
Guichet JM, Deromedis B, Donnan LT, Peretti G, Lascombes P, Bado F (2003) Gradual femoral lengthening with the Albizzia intramedullary nail. J Bone Joint Surg Am 85:838–848
Herzenberg JE, Paley D (1997) Tibial lengthening over nails (LON). Tech Orthop 12:250–259
Herzenberg JE, Scheufele LL, Paley D, Bechtel R, Tepper S (1994) Knee range of motion in isolated femoral lengthening. Clin Orthop 301:49–54
Krettek C, Miclau T, Grun O, Schandelmaier P, Tscherne H (1998) Intraoperative control of axes, rotation and length in femoral and tibial fractures. Technical note. Injury 29 [Suppl 3]:29–39
Maffulli N, Lombari C, Matarazzo L, Nele U, Pagnotta G, Fixsen JA (1996) A review of 240 patients undergoing distraction osteogenesis for congenital post-traumatic or postinfective lower limb length discrepancy. J Am Coll Surg 182:394–402
Noonan KJ, Leyes M, Forriol F, Canadell J (1998) Distraction osteogenesis of the lower extremity with use of monolateral external fixation. A study of two hundred and sixty-one femora and tibiae. J Bone Joint Surg Am 80:793–806
Oedekoven G, Jansen D, Raschke M, Claudi BF (1996) The monorail system-bone segment transport over unreamed interlocking nails. Chirurg 67:1069–1079
Paley D (1990) Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop 250:81–104
Paley D, Herzenberg JE, Paremain G, Bhave A (1997) Femoral lengthening over an intramedullary nail. A matched-case comparison with Ilizarov femoral lengthening. J Bone Joint Surg Am 79:1464–1480
Paley D, Herzenberg JE, Tetsworth K, McKie J, Bhave A (1994) Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am 25:425–465
Paley D, Tetsworth K (1991) Percutaneous osteotomies. Osteotome and Gigli saw techniques. Orthop Clin North Am 22:613–624
Raschke MJ, Mann JW, Oedekoven G, Claudi BF (1992) Segmental transport after unreamed intramedullary nailing. Preliminary report of a “Monorail” system. Clin Orthop 282:233–240
Siebenrock KA, Gerich T, Jakob RP (1997) Sequential intramedullary nailing of open tibial shaft fractures after external fixation. Arch Orthop Trauma Surg 116:32–36
Simpson AH, Cole AS, Kenwright J (1999) Leg lengthening over an intramedullary nail. J Bone Joint Surg Br 81:1041–1045
Simpson AH, Kenwright J (2000) Fracture after distraction osteogenesis. J Bone Joint Surg Br 82:659–665
Tjernstrom B, Olerud S, Rehnberg L (1994) Limb lengthening by callus distraction. Complications in 53 cases operated 1980–1991. Acta Orthop Scand 65:447–455
Young N, Bell DF, Anthony A (1994) Pediatric pain patterns during Ilizarov treatment of limb length discrepancy and angular deformity. J Pediatr Orthop14:352–357
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hankemeier, S., Pape, HC., Gosling, T. et al. Improved comfort in lower limb lengthening with the intramedullary skeletal kinetic distractor. Arch Orthop Trauma Surg 124, 129–133 (2004). https://doi.org/10.1007/s00402-003-0625-6
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-003-0625-6