title: Limb lengthening and then insertion of an intramedullary nail: a case-matched comparison.
abstract: Distraction osteogenesis is an effective method for lengthening, deformity correction, and treatment of nonunions and bone defects. The classic method uses an external fixator for both distraction and consolidation leading to lengthy times in frames and there is a risk of refracture after frame removal. We suggest a new technique: lengthening and then nailing (LATN) technique in which the frame is used for gradual distraction and then a reamed intramedullary nail inserted to support the bone during the consolidation phase, allowing early removal of the external fixator. We performed a retrospective case-matched comparison of patients lengthened with LATN (39 limbs in 27 patients) technique versus the classic (34 limbs in 27 patients). The LATN group wore the external fixator for less time than the classic group (12 versus 29 weeks). The LATN group had a lower external fixation index (0.5 versus 1.9) and a lower bone healing index (0.8 versus 1.9) than the classic group. LATN confers advantages over the classic method including shorter times needed in external fixation, quicker bone healing, and protection against refracture. There are also advantages over the lengthening over a nail and internal lengthening nail techniques.
  
  
  METHODS
  Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Institute for Limb Lengthening and Reconstruction, Limb Lengthening and Deformity Service, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021, USA. RozbruchSR@hss.edu
authors.forename: S Robert
authors.initials: SR
authors.lastname: Rozbruch
authors.forename: Dawn
authors.initials: D
authors.lastname: Kleinman
authors.forename: Austin T
authors.initials: AT
authors.lastname: Fragomen
authors.forename: Svetlana
authors.initials: S
authors.lastname: Ilizarov
mesh_terms: D000328:Adult; D000843:Ankle Joint / Q000503:physiopathology; D001858:Bone Nails; D016267:External Fixators; D005269:Femur / Q000601:surgery*; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology; D016555:Matched-Pair Analysis; D008875:Middle Aged; D019857:Osteogenesis, Distraction / Q000379:methods*; D016059:Range of Motion, Articular; D013977:Tibia / Q000601:surgery*; D055815:Young Adult
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