Femoral Lengthening Over an Intramedullary Nail: A Case of Failed Distraction: A Case Report.

Abstract

Internal bone transport has been used to successfully lengthen diaphyseal bone1. In 1997, Paley et al. described femoral lengthening over a nail (LON), specifically an intramedullary nail, with the use of a unilateral external fixator2. Although this technique is often successful, several complications have been reported, including nonunion of the docking site, infection, pin loosening, fracture, subluxation of the posterior part of the knee or of the patella, and deformation of bone2-8. We report a case of failed femoral LON with a unilateral external fixator related to an oversized intramedullary nail. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A forty-eight-year-old man presented on crutches with the chief symptom of pain in the left hip. He had fallen four months prior and had sustained a femoral neck fracture that had been treated with percutaneous screws at an outside hospital. Radiographs of the left hip revealed a femoral neck nonunion with accompanying posterior and varus collapse. The patient underwent hardware removal, followed by an intertrochanteric valgus osteotomy with a blade plate. The femoral neck nonunion and osteotomy site healed, and the patient was walking independently three months postoperatively. He reported resolution of the left hip pain; however, he had developed pain in the lower back and contralateral hip, which was exacerbated by walking and prolonged standing. Physical examination revealed a shortened left lower extremity. The gait was mildly antalgic with a slight Trendelenburg component. A computed tomography (CT) scanogram demonstrated an overall leg-length discrepancy of 2.9 cm. Because of the symptomatic limb-length discrepancy, the patient elected to pursue femoral LON with a unilateral external fixator. The patient was brought to the operating room and placed in the supine position. The four screws securing …