title: Complications in leg lengthening using an Ilizarov external fixator and intramedullary alignment in children: comparative study during a fourteen-year period.
abstract: BACKGROUND
  The purpose of this retrospective study was to evaluate the complications associated with leg lengthening in children treated with the Ilizarov external fixator (IEF) and compare them between two groups of patients: one group was treated using an IEF alone and the other group was treated using an IEF in association with intramedullary alignment (IA).
  
  
  METHODS
  The study was performed at the University Children's Hospital in Belgrade, Serbia during a fourteen-year period (from 2000 to 2014). Complications occurred in 73 paediatric patients who underwent the leg lengthening procedure. Complications were classified according to the Caton classification and compared between two groups. Group I comprised 39 patients who underwent the limb lengthening procedure using IEF alone. Group II consisted of 34 patients who were treated with the combination of IEF and IA using two Kirschner wires (K-wires) or Titanium Elastic Nails (TEN). The duration of hospital treatment was also compared between the two groups and the impact of the type of IA on the occurrence of complications was assessed.
  
  
  RESULTS
  There was a high rate of complications in patients treated using an IEF compared with those treated using the combination of IEF and IA, but there was no statistically significant difference between the two groups. There was a statistically significant difference in the duration of initial hospitalisation between the two groups, particularly when comparing TEN usage in IA. A comparison of the group of patients treated using an IEF in association with K-wires and patients treated using IEF and TEN showed there was no statistically significant difference in complication rate and duration of initial hospitalisation.
  
  
  CONCLUSIONS
  IA has multiple advantages as a method of treatment of leg length inequality. The major effect of applying IA in association with a circular IEF is significantly reduced complication rate and duration of initial hospitalisation, particularly when using TEN as a method of IA. This method of treatment also decreases hospital costs.
authors.affiliation: Department of Paediatric Orthopaedic Surgery, University Children's Hospital, Belgrade, Serbia. Electronic address: bojanbukva@yahoo.com.
authors.forename: Bojan
authors.initials: B
authors.lastname: Bukva
authors.affiliation: Department of Orthopaedic Surgery, University Hospital "Sveti Duh", Zagreb, Croatia.
authors.forename: Goran
authors.initials: G
authors.lastname: Vrgoč
authors.affiliation: Clinic for Orthopaedic Surgery "Lovran", School of Medicine, University of Rijeka, Rijeka, Croatia.
authors.forename: Ivan
authors.initials: I
authors.lastname: Rakovac
authors.affiliation: Department of Paediatric Orthopaedic Surgery, University Children's Hospital, Belgrade, Serbia.
authors.forename: Siniša
authors.initials: S
authors.lastname: Dučić
authors.affiliation: Institute for Anthropological Research, Zagreb, Croatia.
authors.forename: Joško
authors.initials: J
authors.lastname: Sindik
authors.affiliation: Institute for Anthropological Research, Zagreb, Croatia.
authors.forename: Miran
authors.initials: M
authors.lastname: Čoklo
authors.affiliation: Department of Surgery, University Hospital Rijeka, Rijeka, Croatia.
authors.forename: Marin
authors.initials: M
authors.lastname: Marinović
authors.affiliation: Department of Surgery, General Hospital Karlovac, Karlovac, Croatia.
authors.forename: Bore
authors.initials: B
authors.lastname: Bakota
mesh_terms: D019072:Antibiotic Prophylaxis; D001858:Bone Nails; D001864:Bone Wires; D002648:Child; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary; D006801:Humans; D018889:Ilizarov Technique; D007870:Leg Length Inequality / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D019857:Osteogenesis, Distraction; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D012189:Retrospective Studies; D055771:Serbia / Q000453:epidemiology; D016896:Treatment Outcome
keywords: Children; Complications; Ilizarov method; Intramedullary alignment; Leg lengthening