GRADUAL FEMORAL LENGTHENING WITH THE ALBIZZIA INTRAMEDULLARY NAIL

TLDR

Gradual limb lengthening with external fixation often leads to suboptimal outcomes and complications such as infection, joint stiffness, and axial deviation. The study describes a totally implantable Albizzia intramedullary nail designed to achieve limb lengthening results comparable to external fixation but with fewer complications. The technique involved intramedullary corticotomy of the femur, antegrade insertion of the Albizzia nail, and 15 alternating internal/external rotation maneuvers to elongate the nail by 1 mm, with patients undergoing an average of three operations per limb for insertion, removal, ratcheting, and complication management. The procedure achieved an average femoral length gain of 3.4 cm for unilateral and 6.3 cm for bilateral lengthenings, with no axial deviation, excellent function, and minimal distortion of body image, indicating it is a well tolerated alternative to external fixation.

Abstract

Gradual limb lengthening with currently used external fixation techniques can result in less than optimal outcomes, with complications including infection, stiffness of adjacent joints, and secondary axial deviation of the extremity. We describe a totally implantable lengthening device designed to provide results similar to those achieved with external fixation devices, with fewer complications and improved outcomes.Between 1993 and 1997, thirty-one patients (forty-one femora) underwent limb lengthening with a new internal fixation technique (Albizzia) to treat a congenitally short extremity (thirteen patients), post-traumatic limb-length inequality (eleven patients), or developmental problems (seven patients). Twenty-one patients (twenty-one femora) underwent unilateral surgery to equalize the limb lengths, and ten (twenty femora) underwent bilateral surgery to correct short stature. The mean age was twenty years and one month (range, twelve to thirty-nine years). After intramedullary corticotomy of the diaphysis of the femur, an intramedullary nail was inserted in an antegrade fashion. Fifteen alternating internal and external rotation maneuvers of the lower limb elongated the nail by 1 mm. The outcomes were assessed clinically and radiographically at a mean of fifty months postoperatively.The gain in femoral length averaged 3.4 cm (range, 2 to 5.5 cm) after the unilateral lengthening procedures and 6.3 cm (range, 4.6 to 8.4 cm) after the bilateral procedures. Patients underwent an average of three operations on each limb; these procedures included, in addition to the nail insertion and nail removal, ratcheting under general anesthesia in thirteen limbs and eleven procedures to treat complications in nine patients. At the time of follow-up, no patient had axial deviation of the limb secondary to lengthening.Femoral lengthening with use of the minimally invasive Albizzia technique provides a reasonable alternative to external fixation that is well tolerated by patients and results in excellent function with little or no distortion of body image.