Exchange of Ilizarov External Fixation by Intramedullary Nail, During Callus Consolidation Phase of Limb Lengthening: An Experimental Sheep Model

Abstract

Purpose: To evaluate the effectiveness of external fixation exchange by intramedullary nailing during the consolidation phase following the callus distraction phase.
Methods: In 12 skeletally mature female sheep, equally divided in two groups (group A and group B), we performed tibial shaft osteotomy and 2 cm gradual callus distraction using the Ilizarov external fixator in a 0.5 mm/12 h rate. In group A, the Ilizarov fixator was removed immediately after lengthening completion, and a static unreamed intramedullary nail was inserted. In group B, the Ilizarov device remained during the consolidation phase. The formated callus was studied, with radiographs, ultrasonograms, and triplex. All animals were sacrificed 70 days after osteotomy and bone specimens were evaluated by DEXA and histopathologic examination.
Results: In group A, all animals successfully tolerated intramedullary nailing, keeping limb alignment. All but one formed a mature callus and had entered the remodeling phase keeping callus length, before being sacrificed. One had delayed callus maturation and 0.5 cm loss of callus length, because of failed insertion of the distal locking screw in the nail. In group B, all formed mature callus too, but 2 had serious axis disorders, 3 persistent superficial pin-track infections and 1 deep infection at the same time.
Conclusions: Replacement of the Ilizarov device by static unreamed intramedullary nail during the callus consolidation phase decreases the total duration of external fixation, limits joint stiffness, pin-track infections and axial deformities, and provides protection against refracture. Our results suggest that there is no considerable difference between callus maturation in the two groups.

Distraction osteogenesis - Intramedullary nail - Callus consolidation

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