20 yr old with Poliomyelitis and shortening of his limb with an equinus contacture. The scanogram shows the extent of significant shortening almost 8 cm.
Tibial Lengthening over Nails was chosen since lengthening in Polio takes a long time due to muscular weakness. The frame is carefully applied after the nail is inserted and locked proximally. The corticotomy is made in the upper part of middle third of tibia. The Ilizarov fixator is applied such that the pins are significantly far from the nail. It motors the lengthening at the usual rate of 1 mm per day.
As soon as the length is achieved, the nail is locked distally at the new length and the external fixator is removed. The newly formed bone then hardens in the usual amount of time. The limb lengths are now equal and gait is now significantly better. The equinus deformity has also been corrected.
Bibliography & References:
1) Lengthening over a Nail can safely reduce the duration of External Fixation
Indian J. Orthop. 2008 Jul-Sep; 42(3): 323-329
2) Complications Encountered During Lengthening Over an Intramedullary
Mehmet Kocaoglu, Levent Eralp, Onder Kilicoglu, Halil Burc, and Mehmet Cakmak
J. Bone Joint Surg. Am., Nov 2004; 86: 2406 - 2411.
3) The results of limb lengthening by callus distraction using an extending
intramedullary nail (Fitbone) in non-traumatic disorders
S. Singh, A. Lahiri, and M. Iqbal
J Bone Joint Surg Br, Jul 2006; 88-B: 938 - 942.
4) Leg lengthening over an intramedullary nail
A.H. R. W. Simpson, A. S. Cole, and J. Kenwright
J Bone Joint Surg Br, Nov 1999; 81-B: 1041 - 1045.