Dror Paley, MD
Current techniques of femoral lengthening rely on gradual distraction with use of external fixation to form new bone in the distraction gap. These techniques of distraction osteogenesis have two distinct phases of treatment: distraction and consolidation. The sum of the distraction and consolidation times is the external fixation time. The consolidation phase is usually twice as long as the distraction phase in children and three to four times longer in adults. The prolonged use of the external fixator is the most difficult aspect of femoral lengthening for the patient to tolerate. When the full extent of the lengthening has been achieved, the patient becomes eager to have the external fixator removed. Premature removal, however, may lead to fracture of the femur, resulting in deformity, shortening, or non-union, or all three.
To reduce the time during which the external fixator must be in place, Dr. Paley developed a method that allows removal of the external fixator at the end of the distraction phase. With use of this method, an intramedullary nail is inserted concomitantly with the external fixator. At the end of the distraction phase, the nail is locked by inserting two screws distally and the external fixator is removed. The intramedullary nail protects the new bone from fracture during the consolidation phase.
For more information on the published evaluating this new method of lengthening over an intramedullary nail compared to the Ilizarov method please visit JBJS.org.
In this VJO video presentation, Dr. Paley demonstrates his technique for femoral lengthening over nail.
- Total Run Time: 14:47 minutes
- Catalog Number: 6016
- VJO Publication Date: February, 2013