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Casestudies  >  Limb Lengthening  >  Tibia Lengthening over Nails

 
Limb Lengthening
 
 

                  Polio with tibial shortening and equinus deformity of ankle which is paritally compensating for shortening                    the shortening creates stresses on the other joints and increases energy expenditure of gait significantly.                            Pre-operative scanogram taken in one film on a bucky has three exposures for the hip, knee and ankle joints and helps determine exact amount of shortening in each segment.

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.

               ilizarov fixator drives the lengthening and is well tolerated as it is on the tibia.                 corticotomy is in upper part of middle third. The nail is special with a lesser Herzog curve as the tibial tuberosity is usually less prominent in Polio due to weakness of Quadriceps. The wires and pins are inserted carefully so as not to touch the nail                        lengthening proceeds at usual rate and care is taken to ensure that there is no significant pin track infection. the nail is locked as soon as the length is achieved.

    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.

               clinical result with limb lengths almost equal              the equinus is also corrected and gait is significantly improved                       post-oeprative xray shows that regenerate bone has consolidated really well

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

Milind Chaudhary

            Indian J. Orthop. 2008 Jul-Sep; 42(3): 323-329

 

2)      Complications Encountered During Lengthening Over an Intramedullary   

Nail

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.