Deformity correction and lengthening of lower legs with an external fixator

Deformities combined with shortening in 34 lower limb segments of 28 patients were treated with an Ilizarov external fixator or a Taylor spatial frame at the same level as the osteotomy. We compared an acute correction group (A) with a gradual correction group (G) in patients undergoing deformity correction followed by lengthening. We retrospectively examined the amount of deformity correction, length gained, distraction index, maturation index, and external fixation index in both groups. The mean age of subjects was 12.9 years for A, 17.9 years for G. The mean deformity correction was 17.8° for A, 25.1° for G. Mean lengthening was 5.5 cm for A, 5.0 cm for G. Mean distraction index was 16.4 days/cm for A, 10.6 days/cm for G (P<0.05). Mean maturation index was 40.5 days/cm for A, 29.5 days/cm for G (P=0.081). Mean external fixation index was 58.6 days/cm for A, 42.5 days/cm for G (P<0.05). The distraction index and external fixation index differences between the two groups were statistically significant. Gradual correction may represent a better approach than acute correction with the use of external fixators to treat deformity combined with shortening

Tibial lengthening over humeral and tibial intramedullary nails in patients with sequelae of poliomyelitis: a comparative study

Leg discrepancy is common after poliomyelitis. Tibial lengthening is an effective way to solve this problem. It is believed lengthening over a tibial intramedullary nail can provide a more comfortable lengthening process than by the conventional technique. However, patients with sequelae of poliomyelitis typically have narrow intramedullary canals allowing limited space for inserting a tibial intramedullary nail and Kirschner wires. To overcome this problem, we tried using humeral nails instead of tibial nails in the lengthening procedure. In this study, we used humeral nails in 20 tibial lengthening procedures and compared the results with another group of patients who were treated with tibial lengthening over tibial intramedullary nails. The mean consolidation index, percentage of increase and external fixation index did not show significant differences between the two groups. However, less blood loss and shorter operating time were noted in the humeral nail group. More patients encountered difficulty with the inserted intramedullary nail in the tibial nail group procedure. The complications did not show a statistically significant difference between the two techniques on follow-up. In conclusion, we found the humeral nail lengthening technique was more suitable in leg discrepancy patients with sequelae of poliomyelitis

Tibial lengthening using a reamed type intramedullary nail and an Ilizarov external fixator

The aim of this study was to evaluate the efficacy of tibial lengthening using a reamed type intramedullary nail and an Ilizarov external fixator for the treatment of leg length discrepancy or short stature. This retrospective study was performed on 18 tibiae (13 patients) in which attempts were made to reduce complications. We used an Ilizarov external fixator and a nail (10 mm diameter in 17 tibiae and 11 mm in one tibia) in combination. Average limb lengthening was 4.19 cm (range, 2.5–5.5). The mean duration of external fixation was 12.58 days per centimetre gain in length, and the mean consolidation index was 40.53 (range, 35.45–51.85). All distracted segments healed spontaneously without refracture or malalignment. Gradual limb lengthening using a reamed type intramedullary nail and circular external fixation in combination was found to be reliable and effective and reduced external fixation time with fewer complications