Strategies in Trauma and Limb Reconstruction

Register      Login

VOLUME 11 , ISSUE 2 ( August, 2016 ) > List of Articles

Original Article

A novel intramedullary callus distraction system for the treatment of femoral bone defects

Konstantin Horas, Reinhard Schnettler, Gerrit Maier, Uwe Horas

Keywords : Bone defect treatment, Callus distraction, Distraction osteogenesis, Intramedullary, Bone segment transport

Citation Information : Horas K, Schnettler R, Maier G, Horas U. A novel intramedullary callus distraction system for the treatment of femoral bone defects. 2016; 11 (2):113-121.

DOI: 10.1007/s11751-016-0255-5

License: CC BY-NC-SA 4.0

Published Online: 01-06-2014

Copyright Statement:  Copyright © 2016; The Author(s).


Abstract

An intramedullary device has some advantages over external fixation in callus distraction for bone defect reconstruction. There are difficulties controlling motorized intramedullary devices and monitoring the distraction rate which may lead to poor results. The aim of this study was to design a fully implantable and non-motorized simple distraction nail for the treatment of bone defects. The fully implantable device comprises a tube-in-tube system and a wire pulling mechanism for callus distraction. For the treatment of femoral bone defects, a traction wire, attached to the device at one end, is fixed to the tibial tubercle at its other end. Flexion of the knee joint over a predetermined angle generates a traction force on the wire triggering bone segment transport. This callus distraction system was implanted into the femur of four human cadavers (total 8 femora), and bone segment transport was conducted over 60-mm defects with radiographic monitoring. All bone segments were transported reliably to the docking site. From these preliminary results, we conclude that this callus distraction system offers an alternative to the current intramedullary systems for the treatment of bone defects.


PDF Share
  1. Claes L, Veeser A, Gockelmann M, Horvath D, Durselen L, Ignatius A (2010) A novel method for lateral callus distraction and its importance for the mechano-biology of bone formation. Bone 47(4):712-717
  2. Nayagam S (2010) Femoral lengthening with a rail external fixator: tips and tricks. Strateg Trauma Limb Reconstr 5(3):137-144
  3. Horas K, Schnettler R, Maier G, Schneider G, Horas U (2015) The role of soft-tissue traction forces in bone segment transport for callus distraction: a force measurement cadaver study on eight human femora using a novel intramedullary callus distraction system. Strateg Trauma Limb Reconstr 10(1):21-26
  4. Marsell R, Einhorn TA (2011) The biology of fracture healing. Injury 42(6):551-555
  5. Ilizarov GA (1989) The tension-stress effect on the genesis and growth of tissues. Part I. The influence of stability of fixation and soft-tissue preservation. Clin Orthop Relat Res 238:249-281
  6. Gessmann J, Baecker H, Jettkant B, Muhr G, Seybold D (2011) Direct and indirect loading of the Ilizarov external fixator: the effect on the interfragmentary movements and compressive loads. Strateg Trauma Limb Reconstr 6(1):27-31
  7. Mekhail AO, Abraham E, Gruber B, Gonzalez M (2004) Bone transport in the management of posttraumatic bone defects in the lower extremity. J Trauma 56(2):368-378
  8. Oh CW, Song HR, Roh JY, Oh JK, Min WK, Kyung HS, Kim JW, Kim PT, Ihn JC (2008) Bone transport over an intramedullary nail for reconstruction of long bone defects in tibia. Arch Orthop Trauma Surg 128(8):801-808
  9. Sun XT, Easwar TR, Manesh S, Ryu JH, Song SH, Kim SJ, Song HR (2011) Complications and outcome of tibial lengthening using the Ilizarov method with or without a supplementary intramedullary nail: a case-matched comparative study. J Bone Joint Surg Br 93(6):782-787
  10. Liantis P, Mavrogenis AF, Stavropoulos NA, Kanellopoulos AD, Papagelopoulos PJ, Soucacos PN, Babis GC (2014) Risk factors for and complications of distraction osteogenesis. Eur J Orthop Surg Traumatol 5:693-698
  11. Guichet JM, Deromedis B, Donnan LT, Peretti G, Lascombes P, Bado F (2003) Gradual femoral lengthening with the Albizzia intramedullary nail. J Bone Joint Surg Am 85-A(5):838-848
  12. Betz A, Baumgart R, Schweiberer L (1990) First fully implantable intramedullary system for callus distraction-intramedullary nail with programmable drive for leg lengthening and segment displacement. Principles and initial clinical results. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizien 61(8):605-609
  13. Cole JD, Justin D, Kasparis T, DeVlught D, Knobloch C (2001) The intramedullary skeletal kinetic distractor (ISKD): first clinical results of a new intramedullary nail for lengthening of the femur and tibia. Injury 32(Suppl 4):SD129-SD139
  14. Konofaos P, Kashyap A, Neel MD, Ver Halen JP (2012) A novel device for long bone osteodistraction: description of device and case series. Plast Reconstr Surg 130(3):418e-422e
  15. Baumgart R, Betz A, Schweiberer L (1997) A fully implantable motorized intramedullary nail for limb lengthening and bone transport. Clin Orthop Relat Res 343:135-143
  16. Garcia-Cimbrelo E, Curto de la Mano A, Garcia-Rey E, Cordero J, Marti-Ciruelos R (2002) The intramedullary elongation nail for femoral lengthening. J Bone Joint Surg Br 84(7):971-977
  17. Schiedel FM, Pip S, Wacker S, Popping J, Tretow H, Leidinger B, Rodl R (2011) Intramedullary limb lengthening with the Intramedullary Skeletal Kinetic Distractor in the lower limb. J Bone Joint Surg Br 93(6):788-792
  18. Simpson AH, Shalaby H, Keenan G (2009) Femoral lengthening with the Intramedullary Skeletal Kinetic Distractor. J Bone Joint Surg Br 91(7):955-961
  19. Kenawey M, Krettek C, Liodakis E, Wiebking U, Hankemeier S (2011) Leg lengthening using intramedullay skeletal kinetic distractor: results of 57 consecutive applications. Injury 42(2):150-155
  20. Burghardt RD, Herzenberg JE, Specht SC, Paley D (2011) Mechanical failure of the Intramedullary Skeletal Kinetic Distractor in limb lengthening. J Bone Joint Surg Br 93(5):639-643
  21. Masquelet AC, Fitoussi F, Begue T, Muller GP (2000) Reconstruction of the long bones by the induced membrane and spongy autograft. Ann Chir Plast Esthet 45(3):346-353
  22. Bieler D, Franke A, Willms A, Hentsch S, Kollig E (2014) Masquelet technique for reconstruction of osseous defects in a gunshot fracture of the proximal thigh-a case study. Mil Med 179(9):e1053-e1058
  23. Horas U (2006) A novel internal callus distraction system. In: Leung KTG, Schnettler R, Alt V, Haarman HJTM (eds) Practice of Intramedullary Locked Nails. Springer, Berlin, pp 199-210
  24. Contzen H (1987) Development of intramedullary nailing and the interlocking nail. Aktuelle Traumatologie 17(6):250-252
  25. Menzel M (2004) Experimentelle Untersuchung zur Belastbarkeit und Funktion eines neuen Kallusdistraktionssystems unter Berücksichtigung der biologischen Rahmenbedingungen des Knochensegmenttransports. Dissertation, Justus-Liebig Universität, Giessen
  26. Schandelmaier P, Krettek C, Tscherne H (1996) Biomechanical study of nine different tibia locking nails. J Orthop Trauma 10(1):37-44
  27. Schandelmaier P, Farouk O, Krettek C, Reimers N, Mannss J, Tscherne H (2000) Biomechanics of femoral interlocking nails. Injury 31(6):437-443
  28. Hankemeier S, Pape HC, Gosling T, Hufner T, Richter M, Krettek C (2004) Improved comfort in lower limb lengthening with the intramedullary skeletal kinetic distractor. Principles and preliminary clinical experiences. Arch Orthop Trauma Surg 124(2):129-133
  29. Zhang X, Liu T, Li Z, Peng W (2007) Reconstruction with callus distraction for nonunion with bone loss and leg shortening caused by suppurative osteomyelitis of the femur. J Bone Joint Surg Br 89(11):1509-1514
  30. Hyodo A, Kotschi H, Kambic H, Muschler G (1996) Bone transport using intramedullary fixation and a single flexible traction cable. Clin Orthop Relat Res 325:256-268
  31. Paley D, Herzenberg JE, Paremain G, Bhave A (1997) Femoral lengthening over an intramedullary nail. A matched-case comparison with Ilizarov femoral lengthening. J Bone Joint Surg Am 79(10):1464-1480
  32. Kocaoglu M, Eralp L, Bilen FE, Balci HI (2009) Fixator-assisted acute femoral deformity correction and consecutive lengthening over an intramedullary nail. J Bone Joint Surg Am 91(1):152-159
  33. Brunner UH, Cordey J, Kessler S, Rahn BA, Schweiberer L, Perren SM (1993) Bone segment transport in combination with an intramedullary nail. Injury 24(Suppl 2):S29-S44
  34. Liodakis E, Kenawey M, Krettek C, Wiebking U, Hankemeier S (2011) Comparison of 39 post-traumatic tibia bone transports performed with and without the use of an intramedullary rod: the long-term outcomes. Int Orthop 35(9):1397-1402
  35. Paley D (2015) PRECICE intramedullary limb lengthening system. Expert Rev Med Devices 12(3):231-249
  36. Kirane YM, Fragomen AT, Rozbruch SR (2014) Precision of the PRECICE internal bone lengthening nail. Clin Orthop Relat Res 472(12):3869-3878
  37. Singh S, Lahiri A, Iqbal M (2006) The results of limb lengthening by callus distraction using an extending intramedullary nail (Fitbone) in non-traumatic disorders. J Bone Joint Surg Br 88(7):938-942
  38. Krieg AH, Lenze U, Speth BM, Hasler CC (2011) Intramedullary leg lengthening with a motorized nail. Acta Orthop 82(3):344-350
  39. Sangkaew C (2004) Distraction osteogenesis with conventional external fixator for tibial bone loss. Int Orthop 28(3):171-175
  40. Claes L, Augat P, Schorlemmer S, Konrads C, Ignatius A, Ehrnthaller C (2008) Temporary distraction and compression of a diaphyseal osteotomy accelerates bone healing. J Orthop Res 26(6):772-777
  41. Gessmann J, Citak M, Jettkant B, Schildhauer TA, Seybold D (2011) The influence of a weight-bearing platform on the mechanical behavior of two Ilizarov ring fixators: tensioned wires vs. half-pins. J Orthop Surg Res 6:61
  42. Taylor SJ, Walker PS (2001) Forces and moments telemetered from two distal femoral replacements during various activities. J Biomech 34(7):839-848
  43. Taylor SJ, Perry JS, Meswania JM, Donaldson N, Walker PS, Cannon SR (1997) Telemetry of forces from proximal femoral replacements and relevance to fixation. J Biomech 30(3):225-234
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.