SpringerLink
Log in

Limb salvage reconstruction of the lower limb with complex ankle arthrodesis and magnetic internal lengthening nail

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

With advances in orthopedic implants, the use of intramedullary lengthening devices has gained increasing popularity as an alternative technique compared to lengthening with external fixators, with alleged comparable or better outcomes. The aim of this study is to report our single-center technique and outcomes of combined ankle arthrodesis and proximal tibial lengthening using external fixator with a motorized intramedullary nail, respectively.

Method

Fourteen patients with post-traumatic advanced ankle arthritis underwent staged ankle arthrodesis with external fixator and proximal tibial lengthening using the PRECICE® ILN. Amount of shortening, length achieved, bone healing index, infection rate, ankle fusion rate, and ASAMI score were evaluated.

Results

The average age was 44 years old (range, 30–62). The mean follow up is 70 months (range, 43–121.4). The average amount of limb shortening for patients after ankle fusion was 36.7 mm (18–50) while lengthening was 35.9 mm (range, 18–50). Patients had the nail implanted for an average of 479 days (range, 248–730). Ankle fusions were healed in an average of 178.3 days. There were no surgical infections. All osteotomy-lengthening sites healed after an average 202 days (106–365). The mean bone healing index (BHI) was 56.0 days/cm (21.2–123.6) among the whole cohort. There were no cases of nonunion. ASAMI bone scores were excellent or good among all patients.

Conclusion

Ankle arthrodesis with external fixation along with proximal tibial lengthening using motorized IMN yielded high rates of fusion and successful lengthening. This technique could be offered as a reasonable alternative to using external fixation for both purposes.

Level of Evidence

Level IV, Retrospective cohort study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Martin RL, Stewart GW, Conti SF (2007) Posttraumatic ankle arthritis: an update on conservative and surgical management. J Orthop Sports Phys Therapy 37(5):253–259

    Article  Google Scholar 

  2. Paley D, Lamm BM (2005) Ankle joint distraction. Foot Ankle Clin 10(4):685–698

    Article  PubMed  Google Scholar 

  3. Tellisi N, Fragomen AT, Ilizarov S, Rozbruch SR (2008) Limb salvage reconstruction of the ankle with fusion and simultaneous tibial lengthening using the Ilizarov/Taylor spatial frame. HSS J 4(1):32–42

    Article  PubMed  Google Scholar 

  4. Rabinovich RV, Haleem AM, Rozbruch SR (2015) Complex ankle arthrodesis: review of the literature. World J Orthop 6(8):602–613. https://doi.org/10.5312/wjo.v6.i8.602

    Article  PubMed  PubMed Central  Google Scholar 

  5. Stavrakis AI, SooHoo NF (2016) Trends in complication rates following ankle arthrodesis and total ankle replacement. JBJS 98(17):1453–1458

    Article  Google Scholar 

  6. Rozbruch SR (2005) Posttraumatic reconstruction of the ankle using the Ilizarov method. HSS J 1(1):68–88

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hawkins BJ, Langerman R, Anger DM, Calhoun JH (1994) The Ilizarov technique in ankle fusion. Clin Orthop Relat Res 303:217–225

    Article  Google Scholar 

  8. Sakurakichi K, Tsuchiya H, Uehara K, Kabata T, Yamashiro T, Tomita K (2003) Ankle arthrodesis combined with tibial lengthening using the Ilizarov apparatus. J Orthop Sci 8(1):20–25

    Article  PubMed  Google Scholar 

  9. Cierny G, Mader JT, Penninck JJ (2003) The classic: a clinical staging system for adult osteomyelitis. Clin Orthop Related Res 414:7–24

    Article  Google Scholar 

  10. Richter D, Hahn MP, Laun RA, Ekkernkamp A, Muhr G, Ostermann PA (1999) Arthrodesis of the infected ankle and subtalar joint: technique, indications, and results of 45 consecutive cases. J Trauma Acute Care Surg 47(6):1072

    Article  CAS  Google Scholar 

  11. Paley D (1988) Current techniques of limb lengthening. J Pediatr Orthop 8(1):73–92

    Article  CAS  PubMed  Google Scholar 

  12. Karger C, Guille JT, Bowen JR (1993) Lengthening of congenital lower limb deficiencies. Clin Orthop Relat Res 291:236–245

    Article  Google Scholar 

  13. Ilizarov GA (1990) Clinical application of the tension-stress effect for limb lengthening. Clin Orthop Relat Res 250:8–26

    Article  Google Scholar 

  14. De GB, Aldegheri R, Renzi-Brivio L, Trivella G (1987) Limb lengthening by callus distraction (callotasis). J Pediatr Orthop 7(2):129–134

    Article  Google Scholar 

  15. Aquerreta J, Forriol F, Canadell J (1994) Complications of bone lengthening. Int Orthop 18(5):299–303

    Article  CAS  PubMed  Google Scholar 

  16. Burghardt R, Manzotti A, Bhave A, Paley D, Herzenberg J (2016) Tibial lengthening over intramedullary nails: a matched case comparison with Ilizarov tibial lengthening. Bone Joint Res 5(1):1–10

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Paley D (2015) PRECICE intramedullary limb lengthening system. Expert Rev Med Dev 12(3):231–249. https://doi.org/10.1586/17434440.2015.1005604

    Article  CAS  Google Scholar 

  18. Raczkowski JW, Daniszewska B, Zolynski K (2010) Functional scoliosis caused by leg length discrepancy. Arch Med Sci 6(3):393–398. https://doi.org/10.5114/aoms.2010.14262

    Article  PubMed  PubMed Central  Google Scholar 

  19. Knutson GA (2005) Anatomic and functional leg-length inequality: a review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects and clinical significance. Chiropr Osteopat 13:11. https://doi.org/10.1186/1746-1340-13-11

    Article  PubMed  PubMed Central  Google Scholar 

  20. Morrison TA, Sontich JK (2016) Premature consolidation with resultant implant failure using PRECICE femoral nail lengthening: a case report. JBJS Case Connect 6(1):e2. https://doi.org/10.2106/JBJS.CC.O.00059

    Article  PubMed  Google Scholar 

  21. Kirane YM, Fragomen AT, Rozbruch SR (2014) Precision of the PRECICE internal bone lengthening nail. Clin Orthop Relat Res 472(12):3869–3878. https://doi.org/10.1007/s11999-014-3575-0

    Article  PubMed  PubMed Central  Google Scholar 

  22. Fourman MS, Borst EW, Bogner E, Rozbruch SR, Fragomen A (2014) Recombinant human BMP-2 Increases the incidence and rate of healing in complex ankle arthrodesis. Clin Orthop Rel Res 472(2):732–739

    Article  Google Scholar 

  23. Fragomen AT, Borst E, Schachter L, Lyman S, Rozbruch SR (2012) Complex ankle arthrodesis using the Ilizarov method yields high rate of fusion. Clin Orthop Realt Res 470(10):2864–2873

    Article  Google Scholar 

  24. Dabash S, Zhang DT, Rozbruch SR, Fragomen AT (2019) Blocking screw-assisted intramedullary nailing using the reverse-rule-of-thumbs for limb lengthening and deformity correction. Strateg Trauma Limb Reconstr 14(2):77

    Article  Google Scholar 

  25. Vienne P (2005) Interposition arthrodesis of the ankle. Oper Orthop traumatol 17(4–5):502–517

    Article  PubMed  Google Scholar 

  26. Janis L, Krawetz L, Wagner S (1996) Ankle and subtalar fusion utilizing a tricortical bone graft, bone stimulator, and external fixator after avascular necrosis of the talus. J Foot Ankle Surg 35(2):120–126

    Article  CAS  PubMed  Google Scholar 

  27. Bishop AT, Wood MB, Sheetz KK (1995) Arthrodesis of the ankle with a free vascularized autogenous bone graft. Reconstruction of segmental loss of the bone secondary to osteomyelitis, tumor, or trauma. J Bone Joint Surg Am 77(12):1867–1875

    Article  CAS  PubMed  Google Scholar 

  28. Vaidya SV, Song HR, Lee SH, Suh SW, Keny SM, Telang SS (2006) Bifocal tibial corrective osteotomy with lengthening in achondroplasia: an analysis of results and complications. J Pediatr Orthop 26(6):788–793. https://doi.org/10.1097/01.bpo.0000242429.83866.97

    Article  PubMed  Google Scholar 

  29. Wagner P, Burghardt RD, Green SA, Specht SC, Standard SC, Herzenberg JE (2017) PRECICE® magnetically-driven, telescopic, intramedullary lengthening nail: pre-clinical testing and first 30 patients. SICOT-J 3

  30. Hankemeier S, Pape H-C, Gosling T, Hufner T, Richter M, Krettek C (2004) Improved comfort in lower limb lengthening with the intramedullary skeletal kinetic distractor. Arch Orthop Trauma Surg 124(2):129–133

    Article  PubMed  Google Scholar 

  31. Baumgart R, Betz A, Schweiberer L (1997) A fully implantable motorized intramedullary nail for limb lengthening and bone transport. Clin Orthop Relat Res 343:135–143

    Article  Google Scholar 

  32. Guichet J-M, Deromedis B, Donnan LT, Peretti G, Lascombes P, Bado F (2003) Gradual femoral lengthening with the Albizzia intramedullary nail. JBJS 85(5):838–848

    Article  Google Scholar 

  33. Cole JD, Justin D, Kasparis T, DeVlught D, Knobloch C (2001) The intramedullary skeletal kinetic distractor (ISKD): first clinical results of a new intramedullary nail for lengthening of the femur and tibia. Injury 32:129–139

    Article  Google Scholar 

  34. Laubscher M, Mitchell C, Timms A, Goodier D, Calder P (2016) Outcomes following femoral lengthening: an initial comparison of the Precice intramedullary lengthening nail and the LRS external fixator monorail system. Bone Joint J 98(10):1382–1388

    Article  PubMed  Google Scholar 

  35. Calder P, McGrath A, Chasseaud M, Timms A, Goodier W (2013) The precice intramedullary limb lengthening system—early results. In: Orthopaedic Proceedings, The British Editorial Society of Bone and Joint Surgery, vol SUPP_23, pp 11–11

  36. Krieg AH, Lenze U, Speth BM, Hasler CC (2011) Intramedullary leg lengthening with a motorized nail. Acta Orthop 82(3):344–350. https://doi.org/10.3109/17453674.2011.584209

    Article  PubMed  PubMed Central  Google Scholar 

  37. Paley D, Debiparshad K, Balci H, Windisch W, Lichtblau C (2015) Stature lengthening using the PRECICE intramedullary lengthening nail. Tech Orthop 30(3):167–182

    Article  Google Scholar 

  38. Vogt B, Roedl R, Gosheger G, Toporowski G, Laufer A, Theil C, Broeking JN, Frommer A (2020) Tibial lengthening using a retrograde magnetically driven intramedullary lengthening device in 10 patients with preexisting ankle and hindfoot fusion. Acta Orthop 91(6):761–769. https://doi.org/10.1080/17453674.2020.1807222. (Epub 2020 Aug 24 PMID: 32835564)

    Article  PubMed  PubMed Central  Google Scholar 

  39. Frost MW, Rahbek O, Iobst C, Bafor A, Duncan M, Kold S (2023) Complications and risk factors of intramedullary bone lengthening nails: a retrospective multicenter cohort study of 314 FITBONE and PRECICE nails. Acta Orthop. 94:51–59. https://doi.org/10.2340/17453674.2023.8479

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Limb Lengthening and Complex Reconstruction Service, The Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY, 10021, USA

    David T. Zhang, S. Robert Rozbruch & Austin T. Fragomen

  2. Orthopedic Surgery Department, Ain Shams University Hospitals, Cairo, Egypt

    Sherif Dabash

  3. Potomac Valley Hospital, WVU Medicine, 100 Pin Oak Ln., Keyser, WV, 26726, USA

    Sherif Dabash

Authors
  1. Sherif Dabash
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David T. Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Robert Rozbruch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Austin T. Fragomen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sherif Dabash.

Ethics declarations

Conflict of interest

The authors have no conflict of interest to report.

Ethical approval

IRB has been obtained before commencing this research to review the patients’ data.

Informed consent

All the participants have given an informed consent to use their clinical data anonymously in research.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dabash, S., Zhang, D.T., Rozbruch, S.R. et al. Limb salvage reconstruction of the lower limb with complex ankle arthrodesis and magnetic internal lengthening nail. Eur J Orthop Surg Traumatol 34, 1877–1882 (2024). https://doi.org/10.1007/s00590-024-03863-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-024-03863-4

Keywords

Search

Navigation