title: Elastic intramedullary nailing as a complement to Ilizarov's method for forearm lengthening: a comparative pediatric prospective study.
abstract: OBJECTIVE
  Most of the techniques for forearm lengthening involve external fixation to achieve stability and provide progressive distraction. We introduce the use of elastic stable intramedullar nailing (ESIN) in combination with external circular assembly for the procedure. The purpose of this prospective study was to compare Ilizarov's classical technique with this combined technique.
  
  
  METHODS
  Fifty-seven patients, with forearm length discrepancies or deformities either congenital or acquired, were prospectively followed-up. Patients were divided in two groups: 35 had only external fixation, and 22 had external fixation-ESIN combined techniques. Patients were assessed for clinical and radiographic outcome with a mean follow-up of 21 months after external device removal.
  
  
  RESULTS
  Overall lengthening was 45.0mm. Healing index (HI) was 22.2d/cm with the combined technique, and 32.0 d/cm with external fixation. HI was 30% better when ESIN was used, for congenital and for overall cases. Combined technique has a lower complication rate.
  
  
  CONCLUSIONS
  Although forearm lengthening still remains a time-consuming procedure, ESIN can shorten external fixator wearing time. No additional complication occurred and bony complications seem to be limited by the nails. We recommend this technique, which we now use for most of our patients undergoing limb lengthening.
  
  
  METHODS
  Level IV.
authors.affiliation: Department of Pediatric Orthopaedics and Traumatology, Nancy Teaching Hospital Center, Brabois Hospital Group, Children hospital, 5, allée du Morvan, 54511 Vandœuvre, France.
authors.forename: T
authors.initials: T
authors.lastname: Jager
authors.forename: D
authors.initials: D
authors.lastname: Popkov
authors.forename: P
authors.initials: P
authors.lastname: Lascombes
authors.forename: A
authors.initials: A
authors.lastname: Popkov
authors.forename: P
authors.initials: P
authors.lastname: Journeau
mesh_terms: D000293:Adolescent; D050280:Arm Bones / Q000601:surgery*; D001852:Bone Lengthening / Q000295:instrumentation / Q000379:methods*; D001858:Bone Nails; D002648:Child; D002675:Child, Preschool; D020878:Device Removal; D016267:External Fixators; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D018889:Ilizarov Technique; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome