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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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A-D Radiographic examination and diagnosis of a fracture in the regenerate during treatment. Boy (No 5 in Table 2) with femoral lengthening due to achondroplastic short stature, 5 years old: A) at the day of the removal of the fixator. B) day 0, after removal of the frame, one TEN was inserted due to prophylactic stabilization. C) x-ray at day 50 after removal shows a new callus formation within the regenerate, it must have been a fracture type 1b weeks ago, estimated caused by manipulation during insertion of the TEN, no other reason was applicable. D) 4 months (day 133) after removal of the fixator, before removal of the TEN with bony healing without loose of length or development of further malformation. E) late follow up, 1 year after removal of the TEN.
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Figure 3: A-D Radiographic examination and diagnosis of a fracture in the regenerate during treatment. Boy (No 5 in Table 2) with femoral lengthening due to achondroplastic short stature, 5 years old: A) at the day of the removal of the fixator. B) day 0, after removal of the frame, one TEN was inserted due to prophylactic stabilization. C) x-ray at day 50 after removal shows a new callus formation within the regenerate, it must have been a fracture type 1b weeks ago, estimated caused by manipulation during insertion of the TEN, no other reason was applicable. D) 4 months (day 133) after removal of the fixator, before removal of the TEN with bony healing without loose of length or development of further malformation. E) late follow up, 1 year after removal of the TEN.

Mentions: The radiographic findings of one those patients with a fracture Type 1b, seen at day 50 after removal of fixator are shown in Figures 3A - 3D (case no. 5 in Table 2). Tearing of the still-soft tube of callus due to inadvertent extrusion of the rod during implantation may be sufficient here to cause an excessive callus reaction, again with fusiform bone corresponding to initial bone healing, on later radiographs. To prevent the rod from exiting the regenerate, it is recommended that the hammer should not be used. Using only delicate, alternating slight quarter-rotations from the wrist, advancement of the rod can be achieved with the universal-T-handpiece when consistent pressure is applied, without the rod exiting from the soft regenerate Figure 3.


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)

A-D Radiographic examination and diagnosis of a fracture in the regenerate during treatment. Boy (No 5 in Table 2) with femoral lengthening due to achondroplastic short stature, 5 years old: A) at the day of the removal of the fixator. B) day 0, after removal of the frame, one TEN was inserted due to prophylactic stabilization. C) x-ray at day 50 after removal shows a new callus formation within the regenerate, it must have been a fracture type 1b weeks ago, estimated caused by manipulation during insertion of the TEN, no other reason was applicable. D) 4 months (day 133) after removal of the fixator, before removal of the TEN with bony healing without loose of length or development of further malformation. E) late follow up, 1 year after removal of the TEN.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: A-D Radiographic examination and diagnosis of a fracture in the regenerate during treatment. Boy (No 5 in Table 2) with femoral lengthening due to achondroplastic short stature, 5 years old: A) at the day of the removal of the fixator. B) day 0, after removal of the frame, one TEN was inserted due to prophylactic stabilization. C) x-ray at day 50 after removal shows a new callus formation within the regenerate, it must have been a fracture type 1b weeks ago, estimated caused by manipulation during insertion of the TEN, no other reason was applicable. D) 4 months (day 133) after removal of the fixator, before removal of the TEN with bony healing without loose of length or development of further malformation. E) late follow up, 1 year after removal of the TEN.
Mentions: The radiographic findings of one those patients with a fracture Type 1b, seen at day 50 after removal of fixator are shown in Figures 3A - 3D (case no. 5 in Table 2). Tearing of the still-soft tube of callus due to inadvertent extrusion of the rod during implantation may be sufficient here to cause an excessive callus reaction, again with fusiform bone corresponding to initial bone healing, on later radiographs. To prevent the rod from exiting the regenerate, it is recommended that the hammer should not be used. Using only delicate, alternating slight quarter-rotations from the wrist, advancement of the rod can be achieved with the universal-T-handpiece when consistent pressure is applied, without the rod exiting from the soft regenerate Figure 3.

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