title: Complications encountered during lengthening over an intramedullary nail.
abstract: BACKGROUND
  In limb-lengthening, the quest for increased patient comfort and a reduced period of external fixation has led to techniques such as lengthening over an intramedullary nail. The goals of this study were to investigate the rate and types of complications encountered during lengthening over an intramedullary nail and to identify solutions to these complications.
  
  
  METHODS
  Forty-two segments (thirty-five femora and seven tibiae) in thirty-five patients were lengthened. The mean age of the patients was 26.6 years, the mean amount lengthened was 6.3 cm (range, 2.5 to 11.5 cm), the mean external fixation index was 18.7 days/cm, and the mean lengthening index was 31.2 days/cm. The patients were followed for a mean period of forty-four months postoperatively.
  
  
  RESULTS
  Eighteen complications occurred in sixteen (38%) of the forty-two segments for a rate of 0.43 complication per segment. Complications were classified, according to the system of Paley et al., as two problems, thirteen obstacles, and three sequelae. Sixteen of them required additional surgical interventions. A preoperative score of >6.5 on the system of Paley et al., a lengthening of >6 cm, and a lengthening percentage of >21.5% of the original bone length were indicators of a higher probability of the occurrence of complications.
  
  
  CONCLUSIONS
  Lengthening over an intramedullary nail provides increased patient comfort and reduces the external fixation period. If the problems encountered are treated aggressively, the result of the treatment can be quite satisfactory.
authors.affiliation: Department of Orthopaedics and Traumatology, Istanbul Medical School, Istanbul University, Capa, 34390 Topkapi, Istanbul, Turkey. yeralp@superonline.com
authors.forename: Mehmet
authors.initials: M
authors.lastname: Kocaoglu
authors.forename: Levent
authors.initials: L
authors.lastname: Eralp
authors.forename: Onder
authors.initials: O
authors.lastname: Kilicoglu
authors.forename: Halil
authors.initials: H
authors.lastname: Burc
authors.forename: Mehmet
authors.initials: M
authors.lastname: Cakmak
mesh_terms: D000328:Adult; D001852:Bone Lengthening / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D001858:Bone Nails; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D016268:Internal Fixators / Q000009:adverse effects; D011859:Radiography; D013977:Tibia / Q000000981:diagnostic imaging / Q000601:surgery*