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Insufficient Bone Regenerate after Intramedullary Femoral Lengthening: Risk Factors and Classification System Full Text
Clinical Orthopedics and Related Research, 04/06/2010
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Kenawey M et al. – 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.
Mohamed Kenawey (04/06/2010) comments:
Limb lengthening using external fixators was associated with significant complications as infections, adjacent joint stiffness and contractures, axial deviation, refractures, ... etc. Totally implantable intramedullary lengthening nails were recently introduced to avoid the complications associated with the use of external fixators. Intramedullary skeletal kinetic distractor (ISKD) nail is one of the mechanically activated lengthening nails which lengthens through a ratchet mechanism triggered by rotations of 3-9 degrees. Once this nail is implanted in a patient, we have no control over the distraction rate, but we can modify it through instructing the patient to modify his or her level of activity. This lack of control caused distraction problems in many patients. In this work, we analyzed our results in a series of 37 consecutive femoral lengthening using this nail and we found a high rate of insufficient bone regenerate (22%). One of the most important factors which lead to insufficient bone regenerate was a distraction rate more than 1.5 mm/day. Other risk factors were smoking, age 30 years or older, lengthening greater than 40 mm.
