Abstract
BackgroundLower limb loss is a highly disabling medical condition that can severely impact a person’s quality of life. Recovery becomes especially challenging if an amputee has a short residual limb, which can complicate proper prosthetic fitting, causing discomfort, difficulties in suspension, and reduced mobility. Current limb lengthening techniques such as the Ilizarov apparatus and external fixators are cumbersome, uncomfortable, and have high complication rates. In this study, we investigated the effectiveness of a novel limb-lengthening device that uses intramedullary bone lengthening and requires only one percutaneous rod at the end of the limb during the distraction phase. Only the intramedullary nail remains after the distraction phase, and no external components are required during the consolidation phase. We hypothesize that this system would create a much easier experience for the patient.MethodsThe system was first tested in a mock surgical implantation using plastic femur bones. The device was then tested in a series of cadaveric experiments using pelvis-to-knee specimens by a group of surgeons. Surgeons evaluated the surgical insertion technique, soft tissue considerations, hardware fixation strategies, and the effectiveness of the distraction mechanism. Revisions and improvements to the device and surgical procedure were made based on the results from the cadaveric experiments.ResultsA questionnaire was given to two visiting surgeons following the final iteration of the device. The surgeons reported that the system effectively lengthened the limb, was sturdy, and could be installed efficiently. However, there remains a risk of infection and soft tissue imbalances, similar to that introduced by an external fixator device. Suggestions on how to improve the design of the device and mitigate infection through postoperative management and surgical standard of care will be considered for future clinical trials.ConclusionsThe described intramedullary residual limb-lengthening device has evolved from a prototype to a mature model tested in six cadaveric experiments to date. Further mechanical and functional testing is needed to finalize the device before testing in patients.
Highlights
Lower limb loss is a highly disabling medical condition that can severely impact a person’s quality of life
It is generally more preferable to lengthen the residual limb rather than to convert to a higher level of amputation given the major cosmetic and functional restraints associated with hip disarticulation [12]
We developed a stronger clamping mechanism to maintain alignment between the targeting device and limb lengthener
Summary
Lower limb loss is a highly disabling medical condition that can severely impact a person’s quality of life. A short residual limb can be especially distressing for trauma or oncology patients, who are frequently young, but otherwise healthy, and have the potential for significant functional recovery through rehabilitation if fitted with a well-functioning prosthetic device [2]. Kuiken et al Journal of Orthopaedic Surgery and Research (2017) 12:53 residual limb can result in poor prosthetic fitting and wear, difficulty with adductor muscle balancing, and decreased hip strength. These complications combine to result in increased wound complications, increased energy consumption with ambulation, and decreased mobility [2, 4,5,6,7,8,9,10,11]. It is generally more preferable to lengthen the residual limb rather than to convert to a higher level of amputation given the major cosmetic and functional restraints associated with hip disarticulation [12]
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