title: Tibial lengthening: technique for speedy lengthening by external fixation and secondary internal fixation.
abstract: BACKGROUND
  The conventional Ilizarov technique for tibial lengthening is frequently time-consuming, causes suffering, and is associated with many complications. This study takes a retrospective approach to investigate the outcome of applying a slightly speedier procedure using an Ilizarov apparatus and secondary internal fixation.
  
  
  METHODS
  Twelve adult patients displaying tibial shortening (median, 4.0 cm; mean, 4.6 cm; range, 3.0-12.0 cm) with various causes were treated with or without tibial osteotomy and stabilized using an Ilizarov lengthening apparatus. Postoperatively, lengthening of 1 to 1.5 mm/day was performed until the desired length was achieved. External fixation was then converted to internal fixation and either pure autogenous bone graft, or a mixture of autogenous and allogenous bone graft was supplemented. Postoperatively, protected weight bearing was advised until bony union was achieved.
  
  
  RESULTS
  Eleven patients were followed up for a median of 3.4 years (mean, 4.0 years; range, 2.1-6.7 years) and solid union was achieved in all cases. Median external fixation occurred after 1.8 months (mean, 1.9 months; range, 1.2-4.5 months) and the median time until union after internal fixation was 4.5 months (mean, 4.8 months; range, 4-6 months). Two patients with rigid equinus feet required concomitant Achillis tendon lengthening. No other significant complications were noted. Classification of the results revealed that improvement from an unsatisfactory to a satisfactory outcome was achieved in all patients (p < 0.001).
  
  
  CONCLUSIONS
  The described technique shortens the external fixation period and reduces patient suffering. Moreover, a high union rate and a low complication rate are achieved. Subjectively and objectively, patients can achieve satisfactory outcomes. Consequently, the described technique may be considered as an alternative to conventional techniques when indicated.
authors.affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan. ccwu@mail.cgu.edu.tw
authors.forename: Chi-Chuan
authors.initials: CC
authors.lastname: Wu
authors.forename: Wen-Jer
authors.initials: WJ
authors.lastname: Chen
mesh_terms: D000328:Adult; D001852:Bone Lengthening / Q000295:instrumentation / Q000379:methods* / Q000534:rehabilitation; D001858:Bone Nails; D019902:Chondrocytes / Q000637:transplantation; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing; D005684:Gait; D006801:Humans; D018889:Ilizarov Technique / Q000295:instrumentation; D007870:Leg Length Inequality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011051:Poliomyelitis / Q000150:complications; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013977:Tibia / Q000601:surgery*; D013978:Tibial Fractures / Q000601:surgery; D016896:Treatment Outcome