Abstract
Unlike external fixators, the use of solid intramedullary lengthening nails is restricted to defined anatomical preconditions, such as an adequate bone length. Furthermore, all deformity corrections except the lengthening procedure have to be implemented intraoperatively and cannot be adjusted postoperatively. Conversely, even complex deformity corrections can be performed using intramedullary devices after a thorough preoperative planning. For preparation of the intramedullary cavity as well as positioning of the lengthening nail according to the preoperative planning, reaming the medullary canal with rigid reamers which don’t follow the line of least resistance is inevitable. However, the application of solid lengthening nails might be limited, especially in children with ongoing epiphyseal growth, although a central perforation of the growth plate was shown to have no adverse effects on the growth potential. In cases with complex or multilevel deformities, an additional osteotomy and locking plate fixation could sometimes be a valuable solution in order to avoid external fixation. The low complication rate as well as the reduced compromising of soft tissues and periosteum render intramedullary lengthening nails the state-of-the-art procedure for limb lengthening in combination with deformity correction in patients who meet the anatomical preconditions.
Highlights
Historical overview of leg lengtheningOne of the first pioneers of leg lengthening was Alesandro Codivilla who, in 1903, performed femoral osteotomies in patients with coxa vara by applying traction via a cast and a transcalcaneal wire [1]
Unlike external fixators, the use of solid intramedullary lengthening nails is restricted to defined anatomical preconditions, such as an adequate bone length
The low complication rate as well as the reduced compromising of soft tissues and periosteum render intramedullary lengthening nails the state-of-the-art procedure for limb lengthening in combination with deformity correction in patients who meet the anatomical preconditions
Summary
One of the first pioneers of leg lengthening was Alesandro Codivilla who, in 1903, performed femoral osteotomies in patients with coxa vara by applying traction via a cast and a transcalcaneal wire [1]. The main breakthrough came with the observations of Gavril Ilizarov (1921–1992), a general practitioner in Kurgan (southwest Siberia, Russia) who treated countless numbers of war veterans for posttraumatic deformities, infected pseudarthroses, and bony defects [5] He defined the main principles of leg lengthening and deformity correction such as the importance of a percutaneous corticotomy, a latency period of some days, a semi-rigid fixation and a defined distraction distance of 1 mm/day, which are still valid until today [5]. In the same year (1981), Ilizarov was invited to present his work at an AO infection conference in Lecco (Italy), initiating regular exchanges between Ilizarov and surgeons from the western world [7] Another fundamental step was the introduction of intramedullary lengthening devices in the 1970s. After preparing a meticulous preoperative planning, even complex deformity corrections are feasible with intramedullary lengthening devices when using straight rigid reamers (see below)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
