Abstract
An intramedullary nail with two telescoping parts, which can gradually distract two bone segments was developed. The implant is driven by a hydraulic mechanism connected to the tip of the nail via an insert tube, which ends outside the body. The mechanism of lengthening or transport is easy to understand and simple to use. Lengthening up to 8 cm and transport up to 5.5 cm can be achieved with this method. The pressure medium used to push the distal part of the telescope nail down the intramedullary is arachis oil because of its better rheology properties and the excellent resistance against bacterial growth. Eighty-five patients were treated with the hydraulic nail, 48 tibiae and 37 femora. In all except two cases, the indication was a post-traumatic bone healing problem. Daily distraction was applied. In all except one case, bone healing was obtained. Major complications such as implant failure or rupture of the inlet tube have been addressed by change of the used materials. The advantage of the described method is reduced distraction time, avoidance of a long standing external fixation system, its simplicity of use and its reduced cost.
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References
Ilizarov GA. The tension-stress effects on the genesis and growth of tissues: Part I. The influence of stability of fixation and soft tissue preservation. Clin Orthop Relat Res. 1989;238:249–81.
Ilizarov GA. Clinical application of tension stress effects for limb lengthening. Clin Orthop Rel Res. 1990;250:8–26.
Wagner H. Operative lengthening of the femur. Clin Orthop Relat Res. 1978;136:125–42.
Siffert R. Current concept review. Lower limb-length discrepancy. J Bone Joint Surg Am. 1987;69:1100–6.
Götz J, Schellmann WD. Continuous lengthening of the femur with intramedullary stabilisation. Arch Orthop Unfallchir. 1975;82:​305–10.
Matano T, Tamai K, Kurokawa T. Adaptation of skeletal muscle in limb lengthening: a light diffraction study on the sarcomere length in situ. J Orthop Res. 1994;12:193–6.
Fink B, Krieger M, Strauss JM, Opheys C, Menkhaus S, Fischer J, Rüther W. Osteogenesis and its influencing factors during treatment with the Ilizarov method. Clin Orthop Rel Res. 1996;323:261–72.
Green SA. Skeletal defects. A comparison of bone grafting and bone transport for segmental skeletal defects. Clin Orthop Rel Res. 1994;301:111–7.
Herbert AJ, Herzenberg JE, Paley D. Review for pediatricians on limb lengthening and the Ilizarov method. Curr Opin Pediatr. 1995;71:98–105.
Wiedemann M. Morphologische Grundlagen der Kallusdistraktion. Zentralbl Chir. 1994;119:587–93.
Motmans R, Lammens J. Knee range of motion in femoral lengthening by Ilizarov. 2002. Thesis, Catholic University of Leuven.
Guichet JM, Casar RS. Mechanical characterization of a totally intramedullary gradual elongation nail. Clin Orthop Rel Res. 1997;337:281–90.
Guichet JM, Grammont PM, Trouilloud P. A nail for progressive lengthening. An animal experiment with a 2-year follow-up. Chirurgie. 1992;118:405–10.
Guichet JM. Clou centro-médullaire d’allongement progressif femoral (Allizzia): résultats des 52 premiers cas (48 patients). Rev Chir Orthop et Reparatrice Appar Mot. 1995;81:170–95.
Guichet JM, Deromedis B, Donnan LT, Peretti G, Lascombes P, Bado F. Gradual femoral lengthening with the Albizzia intramedullary nail. J Bone Joint Surg Am. 2003;85-A:838–48.
Singh S, Lahiri A, Iqbal M. The results of limb lengthening by callus distraction using an extending extramedullary nail (Fitbone®) in non-traumatic disorders. J Bone Joint Surg Br. 2006;88-B:938–42.
Burghardt RD, Herzenberg JE, Specht SC, Paley D. Mechanical failure of intramedullary skeletal kinetic distractor in limb lengthening. J Bone Joint Surg Br. 2011;93-B:639–43.
Baumgart R, Betz A. A fully implantable motorized intramedullary nail for limb lengthening and bone transport. Clin Orthop Rel Res. 1997;343:135–43.
Garcia-Cimbrelo E, Curto de la Mano A, Garcia-Rey E, Cordero J, Marti-Ciruelos R. The intramedullary elongation nail for femoral lengthening. J Bone Surg Br. 2002;84-B:971–7.
Young VL, et al. Biocompatibility of radiolucent breast implants. Plast Reconstr Surg. 1991;88:462–74.
Kenawey M, Krettek C, Liodakis E, Wiebking U, Hankemeier S. Leg lengthening using intramedullary skeletal kinetic distractor: results of 57 consecutive applications. Injury. 2011;42:150–5.
Giannoudis PV, Faour O, Goff T, Kanakaris N, Dimitriou R. Masquelet technique for the treatment of bone defects: tips-tricks and future directions. Injury. 2011;42:591–8.
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© 2015 Springer-Verlag London
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Reynders-Frederix, P.A., Dobre, C. (2015). Limb Lengthening: Hydraulically Driven. In: Rommens, P., Hessmann, M. (eds) Intramedullary Nailing. Springer, London. https://doi.org/10.1007/978-1-4471-6612-2_30
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DOI: https://doi.org/10.1007/978-1-4471-6612-2_30
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