Femoral lengthening over an intramedullary nail using the external fixator: risk of infection and knee problems in 22 patients with a follow-up of 2 years or more.
BACKGROUND
The time for femoral lengthening is shortened if external fixation is combined with intramedullary nailing. However, several complications have been reported with this procedure.


METHODS
We retrospectively reviewed the outcome of femoral lengthening performed over an intramedullary nail using external fixation in 22 patients. These patients were followed for a mean of 3.2 (2-5.2) years. The mean age was 22 (13-35) years at the time of the index procedure. The mean lengthening was 5 (2.7-8.1) cm and the external fixator was removed after median 20 (8-30) weeks. The mean external fixation index was 24 (11-35) days/cm and the mean consolidation index was 43 (26-55) days/cm of lengthening.


RESULTS
3 patients who had a past history of infection or open trauma developed osteomyelitis which required removal of the nail. There were 4 knee joint complications when the lengthening was over 20%, including posterior knee subluxation and patella subluxation. In 1 patient, the lengthened segment collapsed with breakage of locking screws.


CONCLUSIONS
Although lengthening over a nail can reduce the duration of external fixation, caution is required to prevent major complications.
Song
Hae-Ryong
HR
Korea University Medical Center, Kuro Hospital, Seoul.
Oh
Chang-Wug
CW
Mattoo
Rakesh
R
Park
Byung-Chul
BC
Kim
Sung-Jung
SJ
Park
Il-Hyung
IH
Jeon
In-Ho
IH
Ihn
Joo-Chul
JC
D000293:Adolescent; D000328:Adult; D001852:Bone Lengthening / Q000009:adverse effects / Q000379:methods; D001858:Bone Nails; D016267:External Fixators; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D031221:Knee Dislocation / Q000000981:diagnostic imaging / Q000209:etiology; D007870:Leg Length Inequality / Q000601:surgery*; D008297:Male; D010019:Osteomyelitis / Q000000981:diagnostic imaging / Q000209:etiology; D031222:Patellar Dislocation / Q000000981:diagnostic imaging / Q000209:etiology; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors