Limb Lengthening Forum
Limb Lengthening Surgery => Limb Lengthening Discussions => Topic started by: Ascending on September 25, 2018, 11:13:15 AM
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Hi,
I have been researching and reading the opinions of posters about Tibia lengthening and I note that whilst there is consensus that Femur lengthening is best done using an internal distraction nail, such concensus doesn't exist for the Tibia. My opinion is that a very good internal load bearing nail such as the Stryde trumps external methods mainly because it is more tolerable than external apparatus, has less infection risk and produces less scarring. Interestingly nails are kept in the limb just as long as external fixators post lengthening - the difference being that the internal nail produces less discomfort/inconvenience for the patient and virtually no risk of infection.
Tibia Facts:
- There are two bones that must be broken and extended simultaneously - Tibia (Shin Bone), Fibula (Calf Bone).
- Complications of premature consolidation of one the two bones will lead to bow legs.
- The bones are thinner
- Greater resistance of soft tissue to lengthening when compared with Femurs
- Drop foot/Ballerina seems to be a frequent occurrence
- Blood supply is generally poorer than for the Femur
External Methods
Advantages:
- Load Bearing
- Can precisely control lengthening
- Can correct complex deformities
- Does not require reaming of bone
- Does not damage the knee
- Frame can be reused
- Much cheaper than internal methods
- Suitable for those with small diameter bones - adults and children
- Mechanically simpler than internal methods and problems can be fixed more easily
- Removal of apparatus has very little risk and is cheaper
Disadvantages:
- Pins fix the apparatus to the bones going through the skin and muscles - creating further resistence to muscle stretching. This is more noticable for femural lengthening where the muscle mass is greater.
- Pin Site Infection - great care must be taken when showering
- Frame removal times are very long - removing too early risk fracture. A nail can be inserted after lengthening but this will bring some of the disadvantages with internals methods
- Bulky frame make the surgery very noticeable and make it difficult to sleep - with the exception of Dr. Salameh's Salamehfix fixator
- Pins can and do break requiring replacement
- More scarring than internal methods
Internal Methods
Advantages:
- New nails such as the Stryde nail allow full Load Bearing
- Can precisely control lengthening if using Precice or Stryde
- Very low infection risk, negligible post surgery
- Soft tissue is lengthened without obstruction
- Nails can be kept in until consolidation fully completes without much inconvenience
- Much less scarring than external methods
- Much more comfortable experience for the patient - easier to disguise and easier to sleep
Disadvantages:
- Much more invasive than external methods - requires nail to be inserted through the knee and the bone to be reamed to make room for the nail
- Expensive
- Nails cannot be reused
- Bone marrow is lost from the bone
- Risk of fat embolism - caused by bone marrow being displaced by the nail and entering the bloodstream.
- Nails can bend and break requiring expensive surgery to replace
- The nail lengthening mechanism can break - leading to runaway lengthening or non lengthening
- Nail removal is an expensive and brutal process - nails are hammered out.
- Some nails such as Albizzia derivatives are extended using a very painful mechanical process - not true for Fitbone, Precice and Stryde nails.
- Not suitable for children or adults with thinner bones - more so with load bearing nails which are typically thicker.
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nicely outlines points. i think the external tibias facts outweigh internal tibias.
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Thanks for all the info this has made me re-evaluate my choices when it comes to LL. I'll double check with a doctor because I've really been considering internals.
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Thanks Sanity and ThatGuy. But I would not underestimate the inconvenience of having to wear frames for a year or possibly more depending on length extended and on speed of consolidation. Plus pin-site care is needed. According to Morpheus34 on the old forum, time in the fixator is about 1.5 months per cm lengthened.
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true but when money is a problem external is a savior. p.s although it wil take considerably more time, the long-terms sideeffects will be lesser and stil gets the job done.
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Agreed. If money is an issue then although it may take more time and may require more care to prevent infection, external tibia lengthening makes perfect sense given its many advantages.
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What long term side effects does internal tibia cause that external tibias avoid?