Tibial lengthening using a retrograde magnetically driven intramedullary lengthening device in 10 patients with preexisting ankle and hindfoot fusion

Authors

  • Bjoern Vogt Children’s Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital of Muenster
  • Robert Roedl Children’s Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital of Muenster
  • Georg Gosheger General Orthopedics and Tumor Orthopedics, University Hospital of Muenster, Germany
  • Gregor Toporowski Children’s Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital of Muenster
  • Andrea Laufer Children’s Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital of Muenster
  • Christoph Theil General Orthopedics and Tumor Orthopedics, University Hospital of Muenster, Germany
  • Jan Niklas Broeking Children’s Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital of Muenster
  • Adrien Frommer Children’s Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital of Muenster

DOI:

https://doi.org/10.1080/17453674.2020.1807222

Abstract

Background and purpose — Motorized intramedullary lengthening nails (ILNs) have been developed as an alter- native to external fixators for long bone lengthening. The antegrade approach represents the standard method for tibial ILN insertion. In patients with preexisting ankle and hind- foot fusion a retrograde approach provides an alternative technique that has not been evaluated so far. We report the outcome of this method in 10 patients.

Patients and methods — This retrospective study included 10 patients (mean age 18 years [13–25]) with pre- existing ankle and hindfoot fusion who underwent tibial lengthening with a retrograde ILN (PRECICE). The mean leg length discrepancy (LLD) was 58 mm (36–80). The underlying conditions were congenital (n = 9) and post tumor resection (n = 1). The main outcome measures were: ILN reliability, distraction achieved, distraction index (DIX), time to bone healing, consolidation index (CIX), complica- tions, and functional results.

Results — All patients achieved the goal of lengthening (mean 48 mm [26–80]). Average DIX was 0.6 mm/day (0.5– 0.7) and mean CIX was 44 days/cm (26–60). Delayed con- solidation occurred in 2 patients and healed after ILN dynam- ization or nail exchange with grafting. Toe contractures in 2 other patients were resolved with physiotherapy or tenotomy. Until last follow-up (mean 18 months [12–30]) no true com- plications were encountered, knee motion remained unaf- fected, and full osseous consolidation occurred in all patients.

Interpretation — In patients with LLD and preexisting ankle and hindfoot fusion distal tibial lengthening using a ret- rograde ILN is a reliable alternative to the standard approach with equivalent bone healing potential and low complication rates leaving the knee unaffected.

Downloads

Download data is not yet available.

Downloads

Additional Files

Published

2020-08-24

How to Cite

Vogt, B. ., Roedl, R. ., Gosheger, G. ., Toporowski, G. ., Laufer, A. ., Theil, C. ., Broeking, J. N. ., & Frommer, A. . (2020). Tibial lengthening using a retrograde magnetically driven intramedullary lengthening device in 10 patients with preexisting ankle and hindfoot fusion. Acta Orthopaedica, 91(6), 761–769 . https://doi.org/10.1080/17453674.2020.1807222