Intramedullary leg lengthening with a motorized nail

Figures & data

Figure 1. Fitbone TAA (Telescope Active Actuator) and SAA (Sliding Active Actuator) with control and transmitter unit.

Table 1. Patient characteristics and results

A	B	C	D	E	F	G	H	I	J	K	L	M	N	O
1	16.0	Femur	Posttraumatic	None	35	35	30	0.85	24	35	8	90		a
2	15.2	Tibia	Congenital	Ext, Vari	30	30	28	0.93	38	50	15		79
3	19.0	Tibia	Tumor	Flex, Vari	30	27	29	1.07	22	33	14		85
4	53.0	Femur	Congenital	Ext, Valg	45	45	60	1.33	20	35	14	86
5	15.9	Femur	Posttraumatic	Ext, Vari	30	25	22	0.88	18	31	14	89	87
6	15.2	Tibia	Posttraumatic	Valg	30	30	28	0.93	35	48	13		92	b
7	15.0	Tibia	Congenital	Ext	25	25	27	1.08	36	49	14		86
8	15.7	Femur	Congenital	None	25	27	27	1	17	27	10	86
9	19.5	Femur	Tumour	Valg	40	40	35	0.87	19	29	10	89
10	14.0	Femur	Posttraumatic	None	40	38	29	0.76	16	25	10	91
11	34.5	Femur	Posttraumatic	None	40	38	32	0.84	16	27	12	92
12	19.1	Femur	Congenital	Ext, IR	30	30	29	0.96	23	35	12	88		c
13	16.5	Femur	Tumor	Ext, IR	27	27	33	1.22	44	51	10	90
14	19.3	Tibia	Congenital	Valg	28	31	35	1.12	77	133	14		86	d
15	14.4	Tibia	Congenital	Flex	25	26	27	1.04	40	65	7		88	e
16	15.3	Femur	Congenital	None	30	30	27	0.9	36	47	10	86
17	16.8	Tibia	Congenital	Valg, ER	23	22	22	1	51	63	9		92
18	17.5	Femur	Congenital	Vari, IR	45	42	48	1.14	16	29	12	89
19	17.2	Femur	Posttraumatic	None	30	27	28	1.03	36	49	9	88
20	16.3	Femur	Congenital	Vari	35	37	30	0.81	16	26	9	92
21	15.3	Femur	Infection	Vari	60	60	87	1.45	25	27	10	86
22	19.9	Femur	Posttraumatic	None	35	35	29	0.82	30	41	10	92
23	14.4	Femur	Infection	Valg	80	80	82	1.02	26	27	14	102
24	17.9	Tibia	Congenital	Vari	43	43	61	1.41	22	37	12		91	f
25	14.3	Femur	Congenital	Vari	55	55	51	0.93	30	41	14	86
26	33.9	Tibia	Idiopathic	None	25	22	30	1.36	30	48	14		93
27	11.5	Tibia	Infection	Valg, ER	51	54	49	0.9	13	24	12		86
28	19.0	Tibia	Neurologic (hemiparesis)	Var	25	25	38	1.52	14	34	14		89	g
29	15.8	Femur	Congenital	Vari	40	40	34	0.85	17	20	11	90
30	28.1	Femur	Congenital	Valg	25	20	29	1.45	30	54	15	87		h
31	19.1	Femur	Posttraumatic	IR	43	43	44	1.02	24	37	9	86
32	18,8	Femur	Posttraumatic	None	24	21	35	1.66	37	62	9	88
Mean 19.3				35.9	35.3	37.3	1.06	27	41.8	11.6	89.2	87.9
Median 16.8				30	30.5	30	1.01	24	36.1	12.0	89.0	88.0

A Patient

B Age

C Site

D Diagnosis

E Additional deformity correction

 Ext extension

 ER external rotation

 Flex flexion

 IR internal rotation

 Valg valgisation

 Vari varisation

F Target length, mm

G Length achieved, mm

H Distraction period, days

I Distraction index, mm/day

J Maturation index, days/cm

K Consolidation index, days/cm

L Hospital stay, days

M Postop. mat. dist femur angle (LDFA), degrees

N Postop. med. proximal tibia angle (MPTA), degrees

O Complications

 a Motor failure, device exchange

 b Deep vein thrombosis

 c Knee extension contracture

 d Bolt loosening, running back 10 mm, insufficiant callus formation

 e Bolt loosening, running back 5 mm

 f Increase of pre-existing equinus deformity, delayed callus formation

 g Bolt loosening

 h Bolt loosening; running back 7 mm

Figure 2. Overview of the different indices.

Figure 3. Range of motion 4 months postoperatively, after 5.5 cm of lengthening of the tibia.

Table 2. Summary of case series in peer-reviewed literature

Author	Device	No. of cases
Baumgart et al. 2005	motorized nail	12
Cole et al. 2001	mechanical nail	18
Hankemeier et al. 2005	mechanical nail	4
Guichet et al. 2003	mechanical nail	31
Leidinger et al. 2006	mechanical nail	22
Krieg et al. 2008	motorized nail	8
Betz et al. 1990	motorized nail	3
Garcia-Cimbrelo et al. 2002	mechanical nail	23
Singh et al. 2006	motorized nail	10

Figure 4. Frontal plane double deformity of the tibia with LLD of 5.5 cm in a patient with a history of osteomyelitis in early childhood and of previous operations.

Figure 5. Anteroposterior and lateral radiographs 3 months (left) and 9 months (right) after surgery.

Baumgart R, Thaller P, Hinterwimmer S. A fully implantable, programmable distraction nail (Fitbone): new perspectives for corrective and reconstructive limb surgery. Springer 2005.

 Google Scholar

Cole JD, Justin D, Kasparis T, DeVlught D, Knobloch C. The intramedullary skeletal kinetic distractor (ISKD): first clinical results of a new intramedullary nail for lengthening of the femur and tibia. Injury (Suppl 4) 2001; 32: SD129-39.

 Google Scholar

Hankemeier S, Gosling T, Pape HC, Wiebking U, Krettek C. Limb lengthening with the Intramedullary Skeletal Kinetic Distractor (ISKD). Oper Orthop Traumatol 2005; 17 (1): 79-101.

 PubMedGoogle Scholar

Guichet JM, Deromedis B, Donnan LT, Peretti G, Lascombes P, Bado F. Gradual femoral lengthening with the Albizzia intramedullary nail. J Bone Joint Surg (Am) 2003; 85 (5): 838-48.

 PubMed Web of Science ®Google Scholar

Leidinger B, Winkelmann W, Roedl R. Limb lengthening with a fully implantable mechanical distraction intramedullary nail. Z Orthop Ihre Grenzgeb 2006; 144 (4): 419-26.

 PubMed Web of Science ®Google Scholar

Betz A, Baumgart R, Schweiberer L. First fully implantable intramedullary system for callus distraction--intramedullary nail with programmable drive for leg lengthening and segment displacement. Principles and initial clinical results. Chirurg 1990; 61 (8): 605-9.

 PubMed Web of Science ®Google Scholar

Garcia-Cimbrelo E, Curto de la Mano A, Garcia-Rey E, Cordero J, Marti-Ciruelos R. The intramedullary elongation nail for femoral lengthening. J Bone Joint Surg (Br) 2002; 84 (7): 971-7.

 PubMedGoogle Scholar

Singh S, Lahiri A, Iqbal M. The results of limb lengthening by callus distraction using an extending intramedullary nail (Fitbone) in non-traumatic disorders. J Bone Joint Surg (Br) 2006; 88 (7): 938-42.

 PubMedGoogle Scholar