Humerus Lengthening: A Comparison of the Internal Lengthening Nail to External Fixation

Abstract

Introduction: Magnetic internal lengthening nails (MILNs) have been used for humeral lengthening to avoid complications associated with external fixation. Purpose/Questions: We compared the 1-year Disabilities of the Arm, Shoulder and Hand (DASH) score, adjacent joint range of motion (ROM), bone healing index (BHI), length achieved, distraction rate, and complications when lengthening the humerus using MILN vs using external fixation. Methods: We conducted a retrospective cohort study of 18 patients (22 humeri) from January 2001 to March 2020 divided into 2 groups, the MILN group (7 patients, 7 humeri) and the mono-lateral fixator group (11 patients, 15 humeri). Results: The MILN group showed larger improvement of DASH scores (average 26.8 and 8 for MILN and fixator groups, respectively), less loss of elbow ROM (average 5° and 7° for MILN and fixator groups, respectively), and shorter time to full recovery of elbow ROM (average 39 days and 122 days for MILN and fixator groups, respectively). In the MILN group, there was slower distraction rate (average 0.66 mm/day and 0.86 mm/day for MILN and fixator groups, respectively), less lengthening achieved (average 5.2 cm and 7 cm for MILN and fixator group, respectively), and a lower lengthening percentage (average 19% and 41% for MILN and fixator group, respectively). Bone healing index (BHI) of 0.94 and 0.99 months/cm for the MILN and the fixator groups were similar. Conclusion: Humeral lengthening using the MILN allowed for early full recovery of joint ROM with comparable functional and radiographic outcomes compared with using external fixators.

Keywords

humerus fixator lengthening PRECICE

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References

Al-Sayyad

MJ.

Taylor spatial frame in the treatment of upper extremity conditions. J Pediatr Orthop. 2012;32:169–178.

Balci

Kocaoglu

Sen

Eralp

Batibay

Bilsel

Bilateral humeral lengthening in achondroplasia with unilateral external fixators: is it safe and does it improve daily life?

Bone Joint J. 2015;97-B(11):1577–1581.

Dick

Tietjen

Humeral lengthening for septic neonatal growth arrest. Case report. J Bone Joint Surg Am. 1978;60(8): 1138–1139.

Franchignoni

Vercelli

Giordano

Sartorio

Bravini

Ferriero

Minimal clinically important difference of the disabilities of the arm, shoulder and hand outcome measure (DASH) and its shortened version (QuickDASH). J Orthop Sports Phys Ther. 2014;44(1):30–39.

Fürmetz

Kold

Schuster

Wolf

Thaller

PH.

Lengthening of the humerus with intramedullary lengthening nails-preliminary report. Strategies Trauma Limb Reconstr. 2017;12:99–106.

Green

. Complications of external skeletal fixation. Clin Orthop. 1983(180):109–116.

Hammouda

Standard

Rozbruch

Herzenberg

JE.

Humeral Lengthening with the PRECICE magnetic lengthening nail. HSS J. 2017;13:217–223.

Hassan

Rozbruch

SR.

Antegrade humeral lengthening with the motorized internal lengthening nail. Techniques in Orthopaedics. 2020;35(3):183–188.

Hosny

GA.

Unilateral humeral lengthening in children and adolescents. J Pediatr Orthop B. 2005;14:439–443.

10.

Kashiwagi

Suzuki

Seto

Futami

Bilateral humeral lengthening in achondroplasia. Clin Orthop Relat Res. 2001; 391:251–257.

11.

Katz

Goldberg

Bahar

Yosipovitch

Humeral lengthening for septic neonatal growth arrest. J Hand Surg Am. 1989;14:903–907.

12.

Kirane

Fragomen

Rozbruch

SR.

Precision of the Precice internal lengthening nail. Clin Orthop Relat Res. 2014;472(12):3869–3878.

13.

Kurtz

Rozbruch

SR.

Humerus lengthening with the PRECICE internal lengthening nail. J Pediatr Orthop. 2017; 37:e296–e300.

14.

Lee

Schoeb

Christiansen

Dick

HM.

Operative lengthening of the humerus: indications, benefits, and complications. J Pediatr Orthop. 2005;25:613–616.

15.

Malot

Park

Song

Kwon

Song

HR.

Role of hybrid monolateral fixators in managing humeral length and deformity correction. Acta Orthop. 2013;84(3):280–285.

16.

Morrison

Georgiadis

Dahl

MT.

Lengthening of the humerus using a motorized lengthening nail: a retrospective comparative series. J Pediatr Orthop. 2020;40(6):e479–e486.

17.

Paley

. problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop. 1990(250):81–104.

18.

Pawar

McCoy

Fragomen

Rozbruch

SR.

Does humeral lengthening with monolateral fixation improve function?

Clin Orthop Rel Res. 2013;471:277–283.

19.

Popkov

Haumont

Journeau

Lascombes

Flexible intramedullary nail use in limb lengthening. J Pediatr Orthop. 2010;30(8):910–918.

20.

Rozbruch

Fryman

Bigman

Adler

Use of ultrasound in detection and treatment of nerve compromise in a case of humeral lengthening. HSS J. 2011;7:80–84.

21.

Shevtsov

Popkov

Yerofeev

Prévot

Lascombes

Elastic stable intramedullary nailing in Ilizarov bone lengthening. Rev Chir Orthop Reparatrice Appar Mot. 2004;90(5):399–410. (In French)

22.

Tellisi

Ilizarov

Fragomen

Rozbruch

SR.

Humeral lengthening and deformity correction in ollier’s disease: distraction osteogenesis with a multiaxial correction frame. J Pediatric Orthop B. 2008;17:152–157.

23.

Tiefenboeck

Zak

Wozasek

GE.

Intramedullary magnetically actuated limb lengthening in a patient with congenital humeral limb shortening. Injury. 2016;47:1597–1600.

24.

Tjernström

Olerud

Rehnberg

Limb lengthening by callus distraction: complications in 53 cases operated 1980-1991. Acta Orthop Scand. 1994;65(4):447–455.

25.

Yang

Huang

SC.

Humeral lengthening using the Ilizarov technique. J Formos Med Assoc. 1997;96(4):291–294.

26.

Zdravkovic

Jost

. Rounded data have a high potential for false comparative statistical results as shown with elbow arc of motion. J Shoulder Elbow Surg. 2018;27(2):276–281.

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