The influence of advanced age in bone healing after intramedullary limb lengthening.

Abstract Background: Distraction osteogenesis with an intramedullary motorized nail is a well-established method to treat leg length discrepancy (LLD). The complex process of bone consolidation is affected by age, location, co-morbidities, smoking and gender. The purpose of this case series was to investigate influencing factors in bone regeneration after intramedullary callus distraction. Hypothesis: Advanced age influences the outcome of intramedullary limb lengthening. Patients and Methods: This retrospective analysis included 19 patients after intramedullary telescopic nailing (PRECICE) on the lower limb with a mean age of 43 years. Bone healing was assessed by distraction and healing parameters such as distraction-consolidation time (DCT), distraction index (DI), healing index (HI), lengthening index (LI), and consolidation index (CI). Results: Confounding factors such as smoking, previous operations on the treated bone, but also the occurrence of complications, and the number of revision surgeries are independent of the patients` age. Younger patients showed a shorter distraction distance, a lower DCT, a lower DI, a higher HI, and a higher CI than older patients. The complication rate requiring nail exchange was higher among the younger patients. Bony healing was observed in all age groups treated with a telescopic nail regardless of age. Conclusion: Advanced age did not influence bone healing or complication rate in intramedullary lengthening. However, the conclusion is limited by the small patient number. Level of evidence: IV; Case control study.