Tibial bone lengthening via external fixation: Comparative study of the traditional technique and a technique with intramedullary nail assistance

Abstract

Objective: To compare outcomes and complications when performing bone lengthening with two different techniques: isolated external fixation versus external fixation combined with intramedullary nail.

Material and method: Comparative retrospective study of thirty cases of tibial lengthening divided in two symmetrical groups. Cases were matched based on several variables to maximise homogeneity between the groups. Variables used for comparison were external fixation time, external fixation index, rate of consolidation, clinical outcomes, complications and range of joint motion.

Results: Mean external fixation time was 2.08 months in the group lengthened with nail while the standard group showed 5.85 months (P<.0001). Mean external fixation index was 0.42 months per centimetre in the nail group compared with 1.15 in the group without nail (P<.0001). There were no significant differences in the rate of consolidation (1.23 months per centimetre against 1.15) or in terms of clinical outcomes. We found differences in the rate of complications (1.2 per patient to 2.6) in favour of the technique with nail. There were no differences in the range of motion of ankle joint.

Discussion and conclusions: Lengthening over an intramedullary nail is more effective than using external fixation alone for tibial lengthening with regard to time of external fixation, index of external fixation and complication rate. We found no advantages in terms of consolidation and joint mobility.

Keywords: Alargamiento; Clavo; Comparative; Comparativo; Fijador; Fixator; Intramedular; Intramedullary; Lengthening; Nail.