Flexible Intramedullary Nail Use in Limb Lengthening

Background: The aim of this study is to evaluate the influence of the external fixation associated with flexible intramedullary nailing (FIN) on the healing index (HI) in limb lengthening. Methods: We compared the healing index between 2 groups of children undergone the lengthening of upper and lower limbs carried out with the Ilizarov external fixator alone (group I, 194 cases of lengthening) or with the combination of the Ilizarov external fixator and intramedullary nailing (group II, 92 cases). Two nails of the diameter from 1.5 to 2.0mm with the ray of curvature about 40 degrees to 50 degrees were used for the intramedullary nailing. Results: The HI was less in every subgroup of Group II compared with Group I. A significant difference was noted in congenital pathologies: monofocal monosegmental lengthening at the level of femur and forearm, bifocal lengthening of the tibia, polysegmental lengthening; and in acquired discrepancy: monofocal tibial lengthening, bifocal femoral lengthening, and the forearm lengthening. The reduction of HI was between 60% and 85% in congenital pathologies: monosegmental femur and forearm, bifocal femur and tibia lengthening; and in acquired discrepancy: femur, tibia, humerus and forearm monosegmental lengthening, humerus and tibia bifocal lengthening, and polysegmental in upper and lower limbs. This difference varies from 1.9 days/cm to 19.1 days/cm. That means that the duration of the external fixator was decreased of 20% to 33% of the number of days between the Group I and the Group II. Maximum diminution of HI was noted for monofocal acquired forearm cases (51.3%) and bifocal acquired femoral lengthening cases which (59.9%). Conclusions: The flexible intramedullary nailing allows adding multiple advantages to the method of limb lengthening with the external fixator. Correctly applied the FIN indeed respects the bone biology that is essential during the limb lengthening. The major effect of application of the combination of Ilizarov frame fixation with FIN is a significant decrease of duration of the external osteosynthesis. Level of Evidence: II.