Bone transport of the tibia with a motorized intramedullary lengthening nail — a case report

Open Access This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the source is credited. DOI 10.3109/17453674.2014.908346 Sir–We read with interest the article by Kold and Christensen (2014). However, we think that there are some points that could be discussed. The authors used a custom-made motorized nail for 5 cm bone transport and lengthening instead of acute bone shortening with compression at the nonunion site and lengthening via proximal osteotomy. Acute shortening should be considered for tibial defects of ≤ 3 cm. This method offer the advantage of immediate bone to bone contact which initiate the healing process early. Another advantage is the ability to bone graft the docking site immediately. Furthermore, acute shortening results in a stable fracture which allows the patient to walk and bear weight soon after surgery. This method decreases the time of healing and therefore additional surgeries might have been prevented. Saleh and Rees (1995) compared the results of the treatment of bone defects by bone transport with those of acute limb shortening followed by lengthening. They obtained excellent results in 12 patients and good results in 4. They found a shorter treatment time and fewer complications with the limb shortening and relengthening method. Paley et al. (1989) have discussed the importance of obtaining bone contact for greater stability of the construct and described several methods for obtaining this by open or closed means. Secondly an intramedullary nail with multiaxial locking screws rather than uniaxial locking screws might improve the stability and provide earlier weight bearing. We think that stability of the constructs should be improved as possible in the treatment of such complex cases.