First Results of Intramedullary Compression/ Distraction for Closed Consolidation and Lengthening in Femoral Pseudarthrosis

The treatment of pseudarthrosis of the long bones by compression has been a well-known and successful procedure for many decades. It is also known that distraction osteogenesis following compression can lead to lengthening with the formation of new, highly biologically active bone in the area of the former pseudarthrosis. Treatments of this type were previously carried out using external fixators. Motorized telescopic intramedullary nails are now available instead, which can achieve compression with high force and ensure sufficient stability during the lengthening phase. The most common cause of pseudarthrosis is instability. Many pseudarthroses are caused by an infection, often an inapparent low-grade infection. In cases of non-infected pseudarthroses or low-grade infections, the question of debridement and its extent is still unclear. As part of a registered multicenter study, patients with confirmed pseudarthrosis and length discrepancies of the long tubular bones are to be treated by compression and distraction using fully implantable, motorized telescopic intramedullary nails. The aim is to heal the pseudarthrosis and simultaneously equalize leg length. Patients without appararent infection, as well as those with a low-grade infection that cannot be ruled out, are both included. Another special feature of the study is that the protocol provides for closed treatment, i.e. the pseudarthrosis remains externally untouched. Only intramedullary samples are taken from the region of the pseudarthrosis via the intramedullary nail access and, if the intramedullary nail is already in place, it is examined by sonication. The presentation will describe previous treatment techniques and introduce the study protocol. Initial results will be presented with case examples and their course of treatment, including also the first study patient's result 18 Months after surgery.