Combined high-division distraction osteosynthesis of the femur in children

The authors proposed to perform distraction osteosynthesis of the femur using a robotic high-division distractor combined with using intramedullary elastic reinforcement with bioactive coating in order to improve the effectiveness of this procedure. Purpose of the work consisted in evaluating the characteristics of osteosynthesis period and immediate results of treatment when using this technique. Materials and methods. Femoral lengthening performed in 21 children (at the age of 6-16 years) with congenital and acquired shortening of this segment. Monolocal combined distraction osteosynthesis used in all the cases. Results. The mean amount of lengthening was 4.1 cm (for congenital shortenings) and 4.3 cm (for acquired ones). The index of osteosynthesis - 21.4±0.83 days/cm and 19.0±0.99 days/cm, respectively. The amplitude of motions of the knee recovered within 5-12 months after the fixator removal. The proposed combined technique allowed to reduce the duration of external fixation significantly. In most cases the knee motions recovered within the period below one year after lengthening at the high-division rate. Intramedullary elastic osteosynthesis prevented such complications as secondary displacement of fragments, delayed union, deformity and fractures at the level of lengthening after the fixator removal. In the authors’ series the combined technique of femoral lengthening demonstrated the advantages in terms of reducing the duration of external fixation and the fastest functional recovery after treatment. Conclusion. The combination of robotic high-division distraction and intramedullary elastic reinforcement allowed to avoid some complications or to reduce their incidence significantly.