Hafez M, Nicolaou N, Offiah AC, Giles S, Madan S, Fernandes JA. Femoral lengthening in young patients: An evidence-based comparison between motorized lengthening nails and external fixation. World J Orthop 2021; 12(11): 909-919 [PMID: 34888151 DOI: 10.5312/wjo.v12.i11.909]
Corresponding Author of This Article
Mohamed Hafez, FRCS, Surgeon, Department of Oncology and Metabolism, Sheffield University, Sheffield S10 2TN, United Kingdom. mhafez1@sheffield.ac.uk
Research Domain of This Article
Orthopedics
Article-Type of This Article
Systematic Reviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Nov 18, 2021; 12(11): 909-919 Published online Nov 18, 2021. doi: 10.5312/wjo.v12.i11.909
Femoral lengthening in young patients: An evidence-based comparison between motorized lengthening nails and external fixation
Mohamed Hafez, Nicolas Nicolaou, Amaka C Offiah, Stephen Giles, Sanjeev Madan, James A Fernandes
Mohamed Hafez, Department of Oncology and Metabolism, Sheffield University, Sheffield S10 2TN, United Kingdom
Mohamed Hafez, Nicolas Nicolaou, Stephen Giles, Sanjeev Madan, James A Fernandes, Department of Paedaiatric Limb Reconstruction, Sheffield Children Hospital, Sheffield S10 2TH, United Kingdom
Amaka C Offiah, Department of Radiology, Sheffield Children Hospital, Sheffield S10 2TH, United Kingdom
James A Fernandes, Department of Trauma and Orthopaedics, Sheffield Children Hospital, Sheffield S10 2Th, United Kingdom
Author contributions: Hafez M participated in all steps of the project, including study design, literature search, data collection, data analysis, data interpretation, manuscript preparation, manuscript revision, and approved the final version; Nicolaou N, Offiah A, Giles S, Madan S and Fernandes JA participated in designing the study, supervised the literature search, manuscript preparation, manuscript revision, read and approved the final version.
Supported byChildren’s Hospital Charity and Industry (Nuvasive, CA, United States), No. 5431.
Conflict-of-interest statement: All authors have no conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohamed Hafez, FRCS, Surgeon, Department of Oncology and Metabolism, Sheffield University, Sheffield S10 2TN, United Kingdom. mhafez1@sheffield.ac.uk
Received: June 8, 2021 Peer-review started: June 8, 2021 First decision: July 28, 2021 Revised: August 7, 2021 Accepted: October 11, 2021 Article in press: October 11, 2021 Published online: November 18, 2021 Processing time: 160 Days and 16.7 Hours
Abstract
BACKGROUND
Femoral lengthening is a procedure of great importance in the treatment of congenital and acquired limb deficiencies. Technological advances have led to the latest designs of fully implantable motorized intramedullary lengthening nails. The use of these nails has increased over the last few years.
AIM
To review and critically appraise the literature comparing the outcome of femoral lengthening in children using intramedullary motorized lengthening nails to external fixation.
METHODS
Electronic databases (MEDLINE, CINAHL, EMBASE, Cochrane) were systematically searched in November 2019 for studies comparing the outcome of femoral lengthening in children using magnetic lengthening nails and external fixation. The outcomes included amount of gained length, healing index, complications and patient reported outcomes.
RESULTS
Of the 452 identified studies, only two (retrospective and non-randomized) met the inclusion criteria. A total of 91 femora were included. In both studies, the age of patients treated with nails ranged from 15 to 21 years compared to 9 to 15 years for patients in the external fixation group. Both devices achieved the target length. Prevalence of adverse events was less in the nail (60%-73%) than in the external fixation (81%-100%) group. None of the studies presented patient reported outcomes.
CONCLUSION
The clinical effectiveness of motorized nails is equivalent or superior to external fixation for femoral lengthening in young patients. The available literature is limited and does not provide evidence on patient quality of life or cost effectiveness of the interventions.
Core Tip: Femoral lengthening in young patients using motorized lengthening nails has gained recent popularity. This study reviewed the literature comparing the outcomes of femoral lengthening using motorized lengthening nails and external fixators in this age group. The advantages and complications of each treatment option were discussed.
