Published online Nov 18, 2021. doi: 10.5312/wjo.v12.i11.909
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
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.
Is the extra cost of the motorized intramedullary nails compared to external fixation in children justified?
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.
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.
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.
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.
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.