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Scientific Articles:
Mehmet Kocaoglu, Levent Eralp, Onder Kilicoglu, Halil Burc, and Mehmet Cakmak
Complications Encountered During Lengthening Over an Intramedullary Nail
J Bone Joint Surg Am 2004; 86: 2406-2411 [Abstract] [Full text] [PDF]
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Electronic letters published:

[Read Letter to the Editor] Femoral Lengthening Over an Intramedullary Nail
Ashok Acharya   (31 January 2005)
[Read Letter to the Editor] Dr. Eralp and colleagues respond to Dr. Acharya
Levent Eralp, Mehmet Kocaoglu, Onder Kilicoglu, Halil Burc, Mehmet Cakmak   (31 January 2005)

Femoral Lengthening Over an Intramedullary Nail 31 January 2005
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Ashok Acharya,
Specialist Registrar
Royal Gwent Hospital, Newport NP20 2EE, UK

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Re: Femoral Lengthening Over an Intramedullary Nail

ashokacharya68{at}yahoo.co.uk Ashok Acharya

To the Editor:

I read with interest this article which describes which complications to expect during lengthening over an intramedullary nail. I would like to pose some questions to the authors.

There is no mention in the text about immediate on-table distraction of the osteotomy. As far as I am aware this is standard practice though the authors' practice might differ. Also the latent period of 10 days before beginning distraction seems more than the usually prescribed 5-7 days (1-3). I wonder if these two factors could have been responsible for the premature consolidation of the osteotomy.

I note that the authors used retrograde femoral nails for some femoral lengthenings. When and why did they choose to do so and what effect did this have on the post-op mobilization of the knee? Knee mobility is often a problem in femoral lengthenings. Against this background is additional insult to the knee justified?

What are the advantages of a fibulotomy over a partial fibulectomy? The incison to take one cm of fibula off need not be much longer and the magnitude of the gap at the end of the lengthening does not matter as far as I know.

Finally have the authors considered using if affordable purely intramedullary lengthening devices such as the Albizzia (DePuy, France), the Fitbone (Wittenstein Intens, Germany)? They have all the advantages of lengthening over nails but not the disadvantages (4,5).

References: 1. Barker K.L., Simpson A.H.R.W., Lamb S.E. Loss of knee range of motion in leg lengthening. J Orthop Sport Phys Ther 2001; 31 (5): 238-46. 2. Paley D, Herzenberg J.E., Paremain G., and Bhave A.: Femoral Lengthening over an intramedullary nail. A matched-case comparison with Ilizarov femoral lengthening. J. Bone Joint Surg [Am] 1997; 79-A: 1464-81. 3. Stanitski DF, Bullard M, Armstrong P, Stanitski CL. Results of femoral lengthening using the Ilizarov technique. J Pediatr Orthop. 1995; 15: 224- 31. 4. Guichet JM, Deromedis B, Donnan L T, Peretti G, Lascombes P, Bado F: Gradual femoral lengthening with the Albizzia Intramedullary nail. J. Bone Joint Surg [Am] 2003; 85-A: 838-48. 5. Wittenstein Intens Fitbone. http://www.fitbone.org/fitbone_en/ (Accessed 24/12/04)
Dr. Eralp and colleagues respond to Dr. Acharya 31 January 2005
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Levent Eralp,
Orthopaedic Surgeon
Department of Orthopaedics and Traumatology, Istanbul Medical School, Istanbul University,
Mehmet Kocaoglu, Onder Kilicoglu, Halil Burc, Mehmet Cakmak

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Re: Dr. Eralp and colleagues respond to Dr. Acharya

yeralp{at}superonline.com Levent Eralp, et al.

To the Editor:

We thank Dr. Acharya for his questions. The following is a list of the reader's questions and our answers.

In the literature, the recommended latency period varies between 5 (Ilizarov) to 15 days(1). Our personal preference is to wait for 5-7 days in infants and 8-10 days in adults. The two premature consolidations in the series occurred on the fibula in tibial lengthenings, where the fibulae were not transfixed by K-wires.

With lengthening over a nail, the distal bone segment must be at least 8 centimeters to achieve enough stability. In dwarfs, the original femur is sometimes so short that at the end of lengthening, there is only a short distal segment remaining. In such patients, we applied retrograde nails, which initially extended beyond the piriformis fossa. But at the end of distraction period, the nail was well in the bone with enough amount of bone for stability.

Partial fibulectomy, as recommended by De Bastiani prevents premature consolidation (2).

In our institution, we are applying fully motorized IM nail lengthening with Fitbone since 2 years. This material dates back to a period, where this device was not available. Besides, the amount of lengthening with Fitbone TAA is limited to 5 centimeters.

References:

1.De Bastiani, Operative Principles of Ilizarov. Eds. AB Maiocchi, J Aronso, 1991 Medi Surgical-Milan)

2.(Orthofix External Fixation in Trauma and Orthopedics, eds. De Bastiani, Apley and Goldberg, Springer Verlag, London, 2000, p. 458)