Limb Lengthening with a Fully Implantable, Telescopic, Intramedullary Nail

Limb lengthening with various types of external fixators is performed on patients who have experienced trauma, congenital limb deficiencies, and other causes of limb-length discrepancy. The use of external fixators is associated with pin site infections and pain because of soft-tissue transfixation. The Intramedullary Skeletal Kinetic Distractor (ISKD) is the only internal lengthening device that is approved by the Food and Drug Administration for use in the United States. Careful preoperative planning and patient selection are essential for successful surgery. The device is inserted by using a method similar to that used for inserting standard trauma nails, with some important differences. The operative technique that is used to insert the ISKD is presented. This article includes the tips and techniques that we have learned from using the ISKD in 116 cases during the past 4 years. In addition, details concerning preoperative and postoperative care and strategies that help manage the problems associated with the procedure are provided. One recommendation for lengthening using the ISKD is that the orthopaedic surgeon is aware of the general principles that apply to all cases of limb lengthening. The authors consider the ISKD to be a useful tool in the orthopaedic surgeon's armamentarium when it is properly selected and applied.