title: Femoral lengthening with lengthening over a nail has fewer complications than intramedullary skeletal kinetic distraction.
abstract: BACKGROUND
  Lengthening over a nail and internal lengthening nails have been developed to minimize or eliminate patients' time wearing a frame during femur lengthening. However it is unclear whether either of these two approaches results in faster times to union or fewer complications over the other.
  
  
  OBJECTIVE
  We asked which technique better achieved: (1) the lengthening goals, (2) the distraction rate control, (3) quality of the regenerate bone, (4) fewer complications, and (5) if SF-36 scores and American Academy of Orthopaedic Surgeons Lower Limb Module (AAOS LLM) scores differ in each treatment modality?
  
  
  METHODS
  We retrospectively reviewed the records and radiographs of 11 patients who had 12 Intramedullary Skeletal Kinetic Distractor (ISKD) procedures between 2002 and 2005, and 21 patients with 22 femoral lengthenings performed as lengthening over nail procedures between 2005 and 2009. Details such as leg length discrepancies, operative time, time of removal of the external fixator or ISKD, and any complications encountered were recorded. SF-36 and AAOS LLM scores also were compiled. The minimum followups for the ISKD and the lengthening over nail cohorts were 62 months (average, 76 months; range, 62-93 months) and 13 months (average, 27 months; range, 13-38 months), respectively.
  
  
  RESULTS
  We observed no difference in achieving the lengthening goals between the two procedures. Distraction was not well controlled in the ISKD group; the distraction rates were 1.7 mm per day for the fast group (distraction rate greater than 1 mm/day) and 0.84 mm per day for the slow group (less than 1 mm/day). The lengthening over nail group had an average distraction rate of 0.88 mm per day. One of 20 of the patients who had lengthening over a nail had complications requiring additional unanticipated surgeries whereas six of 12 patients who had femoral lengthening in the ISKD group had such complications.
  
  
  CONCLUSIONS
  Based on our observations, we believe the lengthening over nail technique for femoral lengthening is associated with fewer complications than the ISKD.
  
  
  METHODS
  Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
authors.forename: Shahab
authors.initials: S
authors.lastname: Mahboubian
authors.forename: Matthew
authors.initials: M
authors.lastname: Seah
authors.forename: Austin T
authors.initials: AT
authors.lastname: Fragomen
authors.forename: S Robert
authors.initials: SR
authors.lastname: Rozbruch
mesh_terms: D000328:Adult; D001852:Bone Lengthening / Q000379:methods*; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007870:Leg Length Inequality / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome