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How should we lengthen post-traumatic limb defects? a systematic review and comparison of motorized lengthening systems, combined internal and external fixation and external fixation alone

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Various external fixation systems for lower extremity long bone deformities have been used to various degrees of success, while newer mechanical lengthening nail (MLN) systems offer the potential for improved patient outcomes. Proponents of MLNs argue that they reduce the number of operations, infectious complications, and improve quality of life; however, the evidence to support these claims is scant. This systematic review aims to evaluate the optimal lengthening system for treating post-traumatic long bone deformity.

Methods

The systematic review was conducted in accordance with PRISMA guidelines. PUBMED, EMBASE, CINAHL, and the Cochrane Library were searched for comparative studies of lengthening techniques among adult patients with axial deformities. Studies were screened and data extracted in duplicate. Treatment groups were pooled into external fixation (EF) alone, combined internal and external fixation (CIF), and mechanical lengthening nail (MLN). Outcomes were mean lengthening achieved, lengthening index, and reported complications.

Results

Thirteen studies with 725 patients (mean age: 29.6 years, 74% male) were included. Nearly all of the studies were either prospective or retrospective cohort studies (n = 12), with one randomized controlled trial of moderate study quality. The mean limb lengthening achieved, lengthening index, and rate of reoperation were similar among the MLN, EF, and CIF groups.

Conclusion

The purported decreased the duration of lengthening and the risk of reoperation associated with MLNs was not demonstrated in this review. Patients with post-traumatic leg length deformities remain a challenging patient population to treat, with intervention being associated with high rates of infectious complications and need for revision operations.

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Funding

The research did not receive any funding and none of the participating authors report and conflicts of interests or competing interest.

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Author notes

  1. Daniel Axelrod, Luc Rubinger, Ajay Shah, Pierre Guy, Herman Johal have contributed equally to this work.

Authors and Affiliations

  1. Division of Orthopedic Surgery, McMaster University, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada

    Daniel Axelrod, Luc Rubinger & Herman Johal

  2. McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada

    Ajay Shah & Herman Johal

  3. Division of Orthopedic Surgery, University of British Columbia, 2775 Laurel St Vancouver, British Columbia, Canada

    Pierre Guy

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  1. Daniel Axelrod
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  2. Luc Rubinger
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Correspondence to Daniel Axelrod.

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Axelrod, D., Rubinger, L., Shah, A. et al. How should we lengthen post-traumatic limb defects? a systematic review and comparison of motorized lengthening systems, combined internal and external fixation and external fixation alone. Eur J Orthop Surg Traumatol 31, 1015–1022 (2021). https://doi.org/10.1007/s00590-020-02831-y

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  • DOI: https://doi.org/10.1007/s00590-020-02831-y

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