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Tibial Lengthening Over an Intramedullary Nail with Use of the Ilizarov External Fixator for Idiopathic Short Stature
Hui Wan Park, MD1; Kyu Hyun Yang, MD1; Ki Seok Lee, MD1; Sun Young Joo, MD1; Yoon Hae Kwak, MD1; Hyun Woo Kim, MD1
1 Department of Orthopaedic Surgery, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, South Korea. E-mail address for H.W. Kim: pedhkim@yuhs.ac
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Sep 01;90(9):1970-1978. doi: 10.2106/JBJS.G.00897
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Background: The details regarding bone formation and complication rates associated with tibial lengthening over an intramedullary nail with use of the Ilizarov external fixator have not been reported, to our knowledge. The purpose of this study was to review our experiences with this procedure, performed in individuals with idiopathic short stature. In addition, we compared the results of lengthening over a nail, in terms of the observed bone formation and the complications, with those of the conventional Ilizarov method.

Methods: Eighty-eight tibiae in forty-four individuals with a mean preoperative height (and standard deviation) of 153.7 ± 7.2 cm were included in the study. Thirty-two tibial lengthening procedures were performed with the conventional method and fifty-six, with a nail. The increase in the length of the tibia, the external fixation index, the healing index, and complications were assessed. Three specific concerns, including mobility during the lengthening procedure, the time interval before the patient could return to previous activities after completion of the lengthening, and physical activities at the time of final follow-up, were also assessed.

Results: The mean final height was 160.1 ± 7.0 cm, and the mean gain in tibial length was 6.2 cm (20.0%). There was no difference in the mean gain in tibial length or the healing index between the groups; however, the external fixation index was lower and there were fewer complications per tibia in the group treated with the lengthening over a nail. The individuals treated with lengthening over a nail coped better with outdoor activities during the treatment period than the individuals treated with the conventional Ilizarov method; however, there was no difference in the time until the individual returned to previous activities or in the ability to carry out physical activities at the time of final follow-up between the groups.

Conclusions: Tibial lengthening with use of the Ilizarov external fixator over an intramedullary nail results in new bone formation of a quality equal to that obtained with the conventional Ilizarov method; however, it reduces the duration of external fixation and the rate of complications.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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