The influence of advanced age in bone healing after intramedullary limb lengthening

• Published in: Orthopaedics & traumatology, surgery & research surgery & research, 2021-12, Vol.107 (8), p.103055-103055, Article 103055
• Main Authors: Zak, Lukas, Arnhold, Richard, Tiefenboeck, Thomas M., Wozasek, Gerald E.
• Format: Article
• Language: English
• Subjects: Adult; Bone Lengthening - methods; Bone Nails - adverse effects; Case-Control Studies; Distraction osteogenesis; Femur - surgery; Fracture Fixation, Intramedullary - methods; Humans; Intramedullary limb lengthening; Leg Length Inequality - etiology; Leg Length Inequality - surgery; Osteogenesis, Distraction; Retrospective Studies; Treatment Outcome
• ISSN: 1877-0568; 1877-0568
• DOI: 10.1016/j.otsr.2021.103055

•The lengthening parameter analysis showed the effectiveness of distraction osteogenesis in intramedullary bone lengthening independent from age.•Bony healing was observed in an younger and older group with slightly better healing parameters in the younger patient group.•We found better results in the majority of the distraction parameters in the advanced patient group, even with a larger distraction distance achieved in this cohort.•The indication for bone lengthening was given more generously in younger patients with smaller distraction distance, which indicates that in the older patient group, LLD seemed to be more tolerated.•The complication rate in a post-traumatic patient population is higher than treating a congenital patient group. Distraction osteogenesis with an intramedullary motorized nail is a well-established method to treat leg length discrepancy (LLD). The complex process of bone consolidation is affected by age, location, comorbidities, smoking and gender. The purpose of this case series was to investigate influencing factors in bone regeneration after intramedullary callus distraction. Advanced age influences the outcome of intramedullary limb lengthening. This retrospective analysis included 19 patients after intramedullary telescopic nailing (PRECICE) on the lower limb with a mean age of 43 years. Bone healing was assessed by distraction and healing parameters such as distraction-consolidation time (DCT), distraction index (DI), healing index (HI), lengthening index (LI), and consolidation index (CI). Confounding factors such as smoking, previous operations on the treated bone, but also the occurrence of complications, and the number of revision surgeries are independent of the patients’ age. Younger patients showed a shorter distraction distance, a lower DCT, a lower DI, a higher HI, and a higher CI than older patients. The complication rate requiring nail exchange was higher among the younger patients. Bony healing was observed in all age groups treated with a telescopic nail regardless of age. Advanced age did not influence bone healing or complication rate in intramedullary lengthening. However, the conclusion is limited by the small patient number. IV; Case control study.