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Insufficient Bone Regenerate after Intramedullary Femoral Lengthening: Risk Factors and Classification System

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Control of distraction rate with an intramedullary skeletal kinetic distractor (ISKD) may be problematic and a high distraction rate may result in insufficient bone regenerate.

Questions/purposes

Are distraction problems preventable when using the ISKD, and what are the risk factors for and radiologic types of insufficient bone regenerate during ISKD lengthening?

Patients and Methods

We analyzed 37 consecutive ISKD femoral lengthening procedures in 35 patients with a mean age 33 ± 11 years and minimum followup of 12 months (average, 27 ± 9 months; range, 12–55 months). The average length gain was 42.8 ± 12.9 mm.

Results

Eight patients had problems during distraction: seven had “runaway nails” and one had a nondistracting nail. Insufficient bone regenerate developed in eight patients. Important risk factors were a distraction rate greater than 1.5 mm/day (9.1 times higher risk), age 30 years or older, smoking, and lengthening greater than 4 cm. Less important risk factors identified were creation of the osteotomy at the site of previous trauma or surgery and acute correction of associated deformities. We proposed a radiologic classification for failure of bone regeneration: partial regenerate failure (Type I) or complete failure resulting in a segmental defect subdivided according to a length of 3 cm or less (Type IIa) or greater than 3 cm (Type IIb).

Conclusions

Distraction problems with the ISKD were related mostly to internal malfunction of the lengthening mechanism. A distraction rate greater than 1.5 mm/day should be avoided in femoral intramedullary lengthening. Smoking should be a contraindication for femoral lengthening.

Level of Evidence

Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Mohamed Kenawey MSc, MRCS, Christian Krettek MD, FRACS, FRCSEd, Emmanouil Liodakis MD, Rupert Meller MD & Stefan Hankemeier MD

Authors
  1. Mohamed Kenawey MSc, MRCS
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  2. Christian Krettek MD, FRACS, FRCSEd
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  3. Emmanouil Liodakis MD
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  4. Rupert Meller MD
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  5. Stefan Hankemeier MD
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Corresponding author

Correspondence to Mohamed Kenawey MSc, MRCS.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at the Trauma Department, Hannover Medical School, Hannover, Germany.

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Kenawey, M., Krettek, C., Liodakis, E. et al. Insufficient Bone Regenerate after Intramedullary Femoral Lengthening: Risk Factors and Classification System. Clin Orthop Relat Res 469, 264–273 (2011). https://doi.org/10.1007/s11999-010-1332-6

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  • DOI: https://doi.org/10.1007/s11999-010-1332-6

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