Lengthening of the tibia over an intramedullary nail, using the llizarov external fixator: Major complications and slow consolidation in 9 lengthenings

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Abstract
We lengthened 9 tibial segments over a nail to reduce the time in the external fixator in 5 patients with constitutional shortness. The median lengthening was 7 (5.5–7.3) cm and the external llizarov frame was removed after median 99 (63–125) days. In spite of a short time in the external fixator, consolidation was slow, with a median lengthening index of 4.4 (2.4–6.1) months/cm. The procedure resulted in 3 fatigue fractures of the intramedullary nail or interlocking screws that needed revision and bone grafting. In 1 patient, a deep intramedullary infection occurred. After the experience of these major complications we have returned to the traditonal callotasis lengthening method described by llizarov.