FEMORAL LENGTHENING OVER AN INTRAMEDULLARY NAIL - A MATCHED-CASE COMPARISON WITH ILIZAROV FEMORAL LENGTHENING

Twenty-nine patients (thirty-two femoral had femoral lengthening over an intramedullary nail, with the nail and the external fixator applied concomitantly at the time of the femoral osteotomy, After gradual dis traction at a rate of one millimeter per day, the nail was locked and the fixator was removed, The mean age was twenty-six years (range, ten to fifty-three Sears), and the mean amount of lengthening was 5.8 cen timeters (range, two to thirteen centimeters), For comparison, thirty- one patients (thirty-two limbs) who had had standard Ilizarov femoral lengthening mere matched with the group that had had lengthening over an intramedullary nail; the matching was performed on the basis of the amount of lengthening, the age of the patient, the etiology of the in dication for lengthening, and the level of difficulty of the procedure , Lengthening over an intramedullary nail reduced the average duration of external fixation by almost one-half, The radiographic consolidati on index (the number of months needed for radiographic consolidation f or each centimeter of lengthening) for the limbs that had had lengthen ing over an intramedullary nail was reduced significantly (p < 0.001) compared with that for the matched-case group, The range of motion of the knee returned to normal a mean of 2.2 times faster in the group th at had had lengthening over an intramedullary nail, There were six ref ractures of the distraction bone in the matched-case group, In the gro up that had had lengthening over an intramedullary nail, one nail and one proximal locking screw failed, The over-all rate of complications was 1.4 per cent in the group that had had lengthening over an intrame dullary nail compared with 1.9 per cent in the matched-case group. Wit h the numbers of patients available for study, we could not detect a s ignificant difference between the groups with respect to the operative time (p = 0.124); however, the cost of treatment and the estimated bl ood loss were higher in the group that had had lengthening over an int ramedullary nail. On the basis of clinical and radiographic criteria, there mere twenty-three excellent, seven good, and two fair results in the group that had had lengthening over an intramedullary nail compar ed with twenty-six excellent, four good, and two fair results in the m atched-case group (p = 0.37), The advantages of lengthening over an in tramedullary nail include a decrease in the duration of external fixat ion, protection against refracture, and earlier rehabilitation.