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Prophylactic titanium elastic nailing (TEN) following femoral lengthening (Lengthening then rodding) with one or two nails reduces the risk for secondary interventions after regenerate fractures: a cohort study in monolateral vs. bilateral lengthening procedures.

Schiedel F, Elsner U, Gosheger G, Vogt B, Rödl R - BMC Musculoskelet Disord (2013)

Bottom Line: A soft-tissue infection in one patient led to early removal of one TEN.The rate of secondary interventions was markedly reduced.Usage of one or two TENs did not influence the fracture rate.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Children's Orthopaedics, Deformity Correction and Foot Surgery, Münster University Hospital, Albert-Schweitzer-Campus 1, Münster, D-48149, Germany. frank.schiedel@uni-muenster.de.

ABSTRACT

Background: Femoral fracture rates of up to 30% have been reported following lengthening procedures using fixators. "Lengthening then rodding" uses one or two titanium elastic nails (TENs) for prophylactic intramedullary nailing to reduce this complication. The aim of the study was to decide if usage of only one TEN is safe or has it a higher risk of getting a fracture? And we asked if there is a difference between patients with monolateral or bilateral lengthening procedures according to their fracture rate?

Methods: One or two TENs were implanted in two groups of patients (monolateral and bilateral) after femoral lengthening procedures. The regenerate quality was classified using the Li system and fractures were categorized using the Simpson and Kenwright classification. The follow-up period was at least 1 year after removal of the frame.

Results: Sixty-seven patients with 101 femoral lengthening procedures were included in 2007-2011. Group A included 34 patients with bilateral lengthening due to congenital short stature. Group B consisted of 33 patients with congenital disorders with leg length discrepancies. Seven fractures in six patients were seen in group A and five fractures in group B. One patient had residual shortening of 1 cm, and 11 fractures healed without relevant deviation (< 5°) or shortening (< 5 mm). A soft-tissue infection in one patient led to early removal of one TEN.

Conclusions: Fractures occurred in both groups of patients in total in 12 of the 101 cases (12%). The rate of secondary interventions was markedly reduced. Usage of one or two TENs did not influence the fracture rate.

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Radiographic appearance of the five types of callus shape in the Li classification [[12]: 1, fusiform; 2, cylindrical; 3, concave hourglass shape; 4, incomplete, only lateral; and 5, only central, filiform.
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Figure 1: Radiographic appearance of the five types of callus shape in the Li classification [[12]: 1, fusiform; 2, cylindrical; 3, concave hourglass shape; 4, incomplete, only lateral; and 5, only central, filiform.

Mentions: Epidemiological data, complete medical file, and x-rays were available for the patients included. The minimum follow-up period was set as one year after removal of the TENs. The radiographic shape and density of the regenerate on the day before fixator removal were classified using the Li system (see also Figure 1 and Table 1) [12]. On the day of removal, the consolidated regenerate shape was again described in accordance with this scheme. For summary in Table 2 shape 1–3 were called stable and shape 4 and 5 unstable. Normal or intermediate density was called normal. All low (type 1,2,3 and 4) and intermediate sparse (type 5) and intermediate lucent (type 8) densities were called insufficient. The density types 6,7,9 and 10 were called sufficient. Any measurement was performed by four investigators (one resident and one senior consultant in radiology and one in pediatric orthopaedics) that were blind for the group building and the question of having a risk of fractures. Any complications of fixator treatment that had occurred in the meantime were classified in accordance with the Paley system as problems, obstacles, or complications [1]. Possible fractures in the prophylactic elastic nailed regenerates were described in accordance with the Simpson and Kenwright system (see Figure 2) [15].


Prophylactic titanium elastic nailing (TEN) following femoral lengthening (Lengthening then rodding) with one or two nails reduces the risk for secondary interventions after regenerate fractures: a cohort study in monolateral vs. bilateral lengthening procedures.

Schiedel F, Elsner U, Gosheger G, Vogt B, Rödl R - BMC Musculoskelet Disord (2013)

Radiographic appearance of the five types of callus shape in the Li classification [[12]: 1, fusiform; 2, cylindrical; 3, concave hourglass shape; 4, incomplete, only lateral; and 5, only central, filiform.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4016152&req=5

Figure 1: Radiographic appearance of the five types of callus shape in the Li classification [[12]: 1, fusiform; 2, cylindrical; 3, concave hourglass shape; 4, incomplete, only lateral; and 5, only central, filiform.
Mentions: Epidemiological data, complete medical file, and x-rays were available for the patients included. The minimum follow-up period was set as one year after removal of the TENs. The radiographic shape and density of the regenerate on the day before fixator removal were classified using the Li system (see also Figure 1 and Table 1) [12]. On the day of removal, the consolidated regenerate shape was again described in accordance with this scheme. For summary in Table 2 shape 1–3 were called stable and shape 4 and 5 unstable. Normal or intermediate density was called normal. All low (type 1,2,3 and 4) and intermediate sparse (type 5) and intermediate lucent (type 8) densities were called insufficient. The density types 6,7,9 and 10 were called sufficient. Any measurement was performed by four investigators (one resident and one senior consultant in radiology and one in pediatric orthopaedics) that were blind for the group building and the question of having a risk of fractures. Any complications of fixator treatment that had occurred in the meantime were classified in accordance with the Paley system as problems, obstacles, or complications [1]. Possible fractures in the prophylactic elastic nailed regenerates were described in accordance with the Simpson and Kenwright system (see Figure 2) [15].

Bottom Line: A soft-tissue infection in one patient led to early removal of one TEN.The rate of secondary interventions was markedly reduced.Usage of one or two TENs did not influence the fracture rate.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Children's Orthopaedics, Deformity Correction and Foot Surgery, Münster University Hospital, Albert-Schweitzer-Campus 1, Münster, D-48149, Germany. frank.schiedel@uni-muenster.de.

ABSTRACT

Background: Femoral fracture rates of up to 30% have been reported following lengthening procedures using fixators. "Lengthening then rodding" uses one or two titanium elastic nails (TENs) for prophylactic intramedullary nailing to reduce this complication. The aim of the study was to decide if usage of only one TEN is safe or has it a higher risk of getting a fracture? And we asked if there is a difference between patients with monolateral or bilateral lengthening procedures according to their fracture rate?

Methods: One or two TENs were implanted in two groups of patients (monolateral and bilateral) after femoral lengthening procedures. The regenerate quality was classified using the Li system and fractures were categorized using the Simpson and Kenwright classification. The follow-up period was at least 1 year after removal of the frame.

Results: Sixty-seven patients with 101 femoral lengthening procedures were included in 2007-2011. Group A included 34 patients with bilateral lengthening due to congenital short stature. Group B consisted of 33 patients with congenital disorders with leg length discrepancies. Seven fractures in six patients were seen in group A and five fractures in group B. One patient had residual shortening of 1 cm, and 11 fractures healed without relevant deviation (< 5°) or shortening (< 5 mm). A soft-tissue infection in one patient led to early removal of one TEN.

Conclusions: Fractures occurred in both groups of patients in total in 12 of the 101 cases (12%). The rate of secondary interventions was markedly reduced. Usage of one or two TENs did not influence the fracture rate.

Show MeSH
Related in: MedlinePlus