Page 7 - RESULTS Continued

Four patients treated for developmental LLD gained a mean length of 3.68 cm (1.5 to 6.5 cm). All patients achieved the preoperative goal length without complication. Each patient maintained a mean distraction rate of 1.0 mm/d, and healing was confirmed at 110.3 days postoperatively (90 to 148 d). Six patients treated for posttraumatic LLD achieved a mean length of 3.48 cm (1.7 to 5.0 cm). All patients achieved the preoperative lengthening goal without complication. The mean distraction rate was 0.93 mm/d (0.75 to 1.02 mm/d), and healing was confirmed at 98.5 days postoperatively (52 to 153 d).

Fifteen patients undergoing bilateral lengthening for stature achieved a mean of 4.63 cm (2.7 to 6.5 cm). Seven patients reached their personal preoperative lengthening goals for height augmentation. Eight patients stopped before their personal lengthening goal for a variety of reasons. Three patients stopped lengthening before their personal goals because they needed to get back to work and could not spend the additional time to complete the lengthening and 1 stopped for this reason as well as a developing contracture of the iliotibial band. All the 4 achieved between 4 and 5 cm of lengthening. One teenage patient decided to stop after 2.7 cm, whereas 1 adult patient decided to stop at 4 cm despite both of these patients planning to lengthen 6.5 cm. The decision to stop was personal and not related to pain or dysfunction of the nail. We stopped lengthening in the contralateral limb of the one patient who had unilateral distraction failure to maintain limb lengths. Both achieved between 4.5 and 5.5 cm.

Three nails fractured in 2 patients (Fig. 9). The first patient had progressed to full weight-bearing (without permission). His x-rays at the time showed 2 of 4 cortices healed. The left femoral implant broke and developed a varus-procurvatum deformation. At the time of the fracture the patient was walking up steps on postoperative day 175. He was treated with fixator-assisted closed reduction, followed by removal of the broken hardware, and then exchange nailing with a nontelescopic locking nail. The femur went on to uneventful healing with no loss of length or alignment. The second patient had progressed to full weight-bearing (without permission) and suffered a fracture while walking in the bathroom. The fracture occurred on day 96, when he had 2 of 4 cortices healed. His varus-procurvatum deformation was treated in the same manner as described for the first patient and his left femur healed with no loss of length or alignment. His right femur appeared fully healed at the time. On day 119, his right femur broke reportedly when he was lying in bed. All 4 cortices were healed at the time of the fracture. In all 3 cases the nails broke through the weld of the nail. In 2 through the proximal weld and in 1 through the middle weld. In all 3 there was a visible varus bend present during the distraction. The bend seemed centered at the weld levels.

There were 7 patients in which the mechanism failed to distract. Two of these were due to operator error in applying the ERC device facing the wrong way for a retrograde nail insertion in the femur. Both nails were replaced and lengthening resumed uneventfully. In the other 5 nails the failure of the mechanism was attributed to premature consolidation in one and dense regenerate producing excessive resistance in the other 4. In the premature consolidation case the nail was replaced and a repeat osteotomy performed followed by successful lengthening. The same treatment was carried out for 2 of the dense regenerates with osteotomy at a new level. In 2 of the dense regenerates where the nail would not lengthen further, the patient elected to allow the bones to heal as they were close to the goal of lengthening.

One stature patient developed a deep vein thrombosis 3 days after stopping his oral chemoprophylaxis regimen (Xaralto), and another patient had a superficial infection at an incision site that responded to a short course of oral antibiotics. Two stature patients developed contractures of the iliotibial band during lengthening. One opted to stop the lengthening 1.5 cm short of their preoperative goal but still required a release of the iliotibial band. Another patient underwent surgical release of the iliotibial band, and was able to continue lengthening and achieve the target length bilaterally.