Leg lengthening in children by the combined techniqueusing high-divisional round-the-clock distraction

Introduction. Leg lengthening in children is still indicated for shortenings of different etiology. The combined technique proposed - the procedure of lengthening using a robotic distractor that provided round-the-clock high-divisional lengthening combined with intramedullary reinforcement using elastic rods with bioactive coating, - in order to reduce the number of complications, the duration of external fixation. Purpose. To evaluate the details of surgical technique, the period of osteosynthesis, the developed complications and the immediate results of treatment. Material and methods. The procedure of leg lengthening performed in 17 children (5-16 years old) with congenital and acquired shortening of the segment. Lengthening performed using the robotic autodistractor assembled on the Ilizarov fixator basis. Intramedullary antegrade osteosynthesis performed using elastic rods with bioactive coating. Results. The mean amount of lengthening was 4.3 cm (for congenital shortenings) and 4.2 cm (for acquired ones). The index of osteosynthesis - 22.5±0.86 days/cm and 23.5±0.61 days/cm, respectively. The amplitude of motions of the adjacent joints recovered within 6-12 months after the fixator removal. The following complications developed: local inflammation of soft tissues in 7 patients, but it required wire change only in one case, and the peroneal nerve transitory paresis observed in one case. Conclusion. The main advantage of high-divisional lengthening with a robotic distractor consists in reducing the recovery period of the motions of the joints adjacent the segment being lengthened. Intramedullary reinforcement with elastic rods allows to reduce the duration of external fixation, as well as to avoid the complications related to delayed regeneration of bone tissue.