Leg lengthening over an intramedullary nail

Distraction osteogenesis is widely used for leg lengthening, but often requ ires a long period of external fixation which carries risks of pin-track se psis, malalignment, stiffness of the joint and late fracture of the regener ate. We present the results of 20 cases in which, in an attempt to reduce the ra te of complications, a combination of external fixation and intramedullary nailing was used. The mean gain in length was 4.7 cm (2 to 8.6). The mean t ime of external fixation was 20 days per centimetre gain in length. All dis tracted segments healed spontaneously without refracture or malalignment, T here were three cases of deep infection, two of which occurred in patients who had had previous open fractures of the bone which was being lengthened. All resolved with appropriate treatment. This method allows early rehabilitation, with a rapid return of knee moveme nt. There is a lower rate of complications than occurs when external fixati on is used on its own. The time of external fixation is shorter than in oth er methods of leg lengthening. The high risk of infection calls for caution .