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The Journal of Bone and Joint Surgery (American) 85:838-848 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Gradual Femoral Lengthening with the Albizzia Intramedullary Nail

Jean-Marc Guichet, MD, PhDDSc, Barbara Deromedis, MD, Leo T. Donnan, MD, Giovanni Peretti, MD, Pierre Lascombes, MD and Flavio Bado, MD

Investigation performed at the Children's Hospital, Nancy, France, and the University of Milan, Monza, Italy

Jean-Marc Guichet, MD, PhD, DSc
Médipole Gentilly Saint-Jacques, 13 rue Blaise Pascal, 54320 Maxéville-Nancy, France. E-mail address: j.guichet{at}mageos.com

Barbara Deromedis, MD
Giovanni Peretti, MD
Flavio Bado, MD
Department of Orthopaedics, University of Milan, San Gerardo Hospital, 20052 Monza, Italy

Leo T. Donnan, MD
Department of Orthopaedics, Royal Children's Hospital, Flemington Road, Melbourne 3052, Australia

Pierre Lascombes, MD
Department of Orthopaedics, Children's Hospital, University of Nancy, 54500 Vandoeuvre-Lès-Nancy, France

One or more of the authors have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article. (DePuy supplied royalties to the inventor [J.-M.G.])No funds were received in support of this study. DePuy (Leeds, United Kingdom, and Saint-Priest, France) provided technical support.

Background: Gradual limb lengthening with currently used external fixation techniques can result in less than optimal outcomes, with complications including infection, stiffness of adjacent joints, and secondary axial deviation of the extremity. We describe a totally implantable lengthening device designed to provide results similar to those achieved with external fixation devices, with fewer complications and improved outcomes.

Methods: Between 1993 and 1997, thirty-one patients (forty-one femora) underwent limb lengthening with a new internal fixation technique (Albizzia) to treat a congenitally short extremity (thirteen patients), post-traumatic limb-length inequality (eleven patients), or developmental problems (seven patients). Twenty-one patients (twenty-one femora) underwent unilateral surgery to equalize the limb lengths, and ten (twenty femora) underwent bilateral surgery to correct short stature. The mean age was twenty years and one month (range, twelve to thirty-nine years). After intramedullary corticotomy of the diaphysis of the femur, an intramedullary nail was inserted in an antegrade fashion. Fifteen alternating internal and external rotation maneuvers of the lower limb elongated the nail by 1 mm. The outcomes were assessed clinically and radiographically at a mean of fifty months postoperatively.

Results: The gain in femoral length averaged 3.4 cm (range, 2 to 5.5 cm) after the unilateral lengthening procedures and 6.3 cm (range, 4.6 to 8.4 cm) after the bilateral procedures. Patients underwent an average of three operations on each limb; these procedures included, in addition to the nail insertion and nail removal, ratcheting under general anesthesia in thirteen limbs and eleven procedures to treat complications in nine patients. At the time of follow-up, no patient had axial deviation of the limb secondary to lengthening.

Conclusions: Femoral lengthening with use of the minimally invasive Albizzia technique provides a reasonable alternative to external fixation that is well tolerated by patients and results in excellent function with little or no distortion of body image.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.



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