Pitfalls of lengthening over an intramedullary nail in tibia: A consecutive case series

Background: Lengthening over a nail was introduced to reduce the overall complication rate in the classic Ilizarov method. Previous studies reported that an intramedullary nail could decrease the time of external fixation, prevent anatomic malalignment and collapse; Internal friction, damage to endosteal blood supply and infection rates, however, may be higher. Whether the approach achieves it goals with acceptable complication rates is unclear. The aim of this study was to describe the results and complications of tibial lengthening over a nail. Methods: We retrospectively reviewed 40 patients with 80 lengthened tibial segments over an intramedullary nail between 2004 and 2009. The average age of the patients at the time of surgery was 22 years (range 18-38 years). Functional and psychological outcomes were evaluated using the questionnaires. Results: The average lengthening achieved was 7.73 cm, 23.5% of initial length. The external fixation index was 1.1 months/cm, and bone-healing index was 1.7 month/cm. The most common complications were valgus angulations of tibia in 20 segments (25%) and equinus contracture in 58 segments (72%). Functional and psychological outcomes were satisfactory after surgery. Conclusions: Lengthening over a nail did not fully prevent axial deviation of regenerate. Equinus contracture was the most common complication but it could be rectified by early intervention such as intramuscular recession or an additional foot frame. Limb lengthening increased functional and psychological outcomes even though there were many complications after surgery.