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
ARTICLE HIGHLIGHTS
Research background
For decades external fixation was the only reliable, safe, and reproducible technique for bone lengthening. The use of external fixation declined recently due to the development of motorized lengthening nails. Lengthening nails are expensive.
Research motivation
Is the extra cost of the motorized intramedullary nails compared to external fixation in children justified?
Research objectives
The main objective was to review the literature to compare the clinical effectiveness of motorized lengthening nails to external fixation. Other objectives were to identify differences in the health-related quality of life between the two techniques in current literature.
Research methods
Electronic databases (MEDLINE, CINAHL, EMBASE, Cochrane) were searched, and all relevant studies were considered for analysis based on predetermined inclusion/ exclusion criteria. The subject headings “distraction osteogenesis”, “motorized nails”, ‘’ external fixation’’ and their related key terms were used.
Research results
Only 2 studies out of 452 studies met the inclusion criteria. The ages of the patients ranged from 9 to 21 years. Lengthening nails were effective in achieving the target length with less prevalence of adverse events.
Research conclusions
The clinical effectiveness of lengthening nails was comparable to external fixation. No report on the quality-of-life difference between the 2 techniques during lengthening. No reports on the cost effectiveness of lengthening nails compared to external fixations.
Research perspectives
Further research is necessary in order to ascertain the efficacy of these treatment methods, to optimize patient outcomes and to ensure health care resources are spent appropriately.
