Tibial lengthening evolution: Classic ilizarov, lengthening and then nailing, motorized internal lengthening nail

Introduction: Distraction osteogenesis is an effective method for the treatment of congenital and acquired limb length discrepancy. Lengthening and then nailing (LATN) was developed to decrease the time in external fixation. With the advent of motorized internal lengthening nails (MILN), external fixation has been eliminated and lengthening of the tibia has become a less burdensome process for patients. Methods: We performed a retrospective review of three groups of patients: Twenty-four patients (27 tibiae) using MILN, 20 patients (32 tibiae) using LATN and 24 patients (34 tibiae) using a classic Ilizarov technique. Results: In the MILN group, the average bone healing index (BHI) was 1.5 months/cm, with an average BHI of 0.9 months/cm for LATN patients and 1.9 months/cm for classic patients. There was a statistically significant difference among the three groups (P < 0.001). There were no deep infections in the internal lengthening nail group. There were no nonunions, persistent joint contractures, or significant unintended changes in alignment in any of the groups. Discussion: Applied appropriately, all three techniques are effective and lead to healing without any significant deformity. Conclusion: Motorized internal lengthening of the tibia is an effective treatment option. The LATN technique still allows for longer lengthenings and faster healing than MILN, however, it does require an additional surgery and the need to wear an external fixator.