Limb lengthening with the Intramedullary Skeletal Kinetic Distractor (ISKD).
OBJECTIVE
Callus distraction of the femur or tibia with an intramedullary distractor, which lengthens mechanically through alternating rotations of at least 3 degrees.


METHODS
Femoral or tibial shortening between 20 and 80 mm. Angular and rotational deformities can be corrected at the osteotomy site.


METHODS
Open epiphyses. Small medullary canal (after intramedullary reaming femoral diameter < 14.5 mm, tibial diameter < 12.5 mm). Severe deformities. Insufficient compliance. Osteitis. Soft-tissue infections.


METHODS
Supine position. Femoral shaft osteotomy at the proximal or middle third by multiple drill holes completed with a chisel. For lengthening of the tibia, osteotomy with a Gigli saw is preferred. Control of the rotation by two parallel 3.0-mm Kirschner wires. Correction of angular or rotational deformities. Via stab incision reaming of the medullary canal with a flexible reamer. The femur is overreamed 2.0 mm and the tibia 1.5 mm above the desired implant diameter. Insertion of the Intramedullary Skeletal Kinetic Distractor (ISKD) into the medullary canal and distal locking in freehand technique. Control of the rotation and of the osteotomy gap. Proximal locking with an aiming device. For femoral lengthening 3 days and for tibial lengthening 5 days postoperatively the distraction is begun by increasing mobilization with partial weight bearing, to achieve daily distraction of 1 mm. In case of insufficient distraction, additional rotations are performed by the patient while checking the external monitor that displays the daily and total distraction length.


RESULTS
Intramedullary lengthening with the ISKD was performed in four patients having an average age of 29 years (18-36 years). Two femoral shortenings were combined with complex rotational and angular deformities. The average lengthening of three femora and one tibia was 31 mm (26-40 mm). The average intraoperative blood loss was 230 ml (110-320 ml), the mean surgical time 108 min (90-145 min). The average daily distraction amounted to 1.2 mm (0.9-1.8 mm). Full weight bearing was permitted after 10 weeks (7-14 weeks), return to regular work after 11 weeks (7-16 weeks). At follow-up examination of an average of 2.3 years postoperatively the knee range of motion was full. Consolidation was noted 80 days (51-111 days) postoperatively with an average consolidation index of 2.9 days/mm (1.8-4.1 days/mm). No complications were observed. According to the Paley Score all patients had an excellent outcome.
Hankemeier
Stefan
S
Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, D-30625, Hannover. hankemeier.stefan@mh-hannover.de
Gösling
Thomas
T
Pape
Hans-Christoph
HC
Wiebking
Ulrich
U
Krettek
Christian
C
D000293:Adolescent; D000328:Adult; D019544:Equipment Failure Analysis; D016267:External Fixators; D005260:Female; D005269:Femur / Q000002:abnormalities / Q000601:surgery*; D006801:Humans; D007870:Leg Length Inequality / Q000601:surgery*; D008297:Male; D019857:Osteogenesis, Distraction / Q000295:instrumentation* / Q000379:methods*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D019919:Prosthesis Implantation / Q000295:instrumentation / Q000379:methods; D013977:Tibia / Q000002:abnormalities / Q000601:surgery*; D016896:Treatment Outcome