Complications and functional, psychological outcomes of bilateral tibial lengthening over intramedullary nail: evidence from Vietnam

Background The purpose of this study was to assess the functional, psychological outcomes and complications of bilateral tibial lengthening over intramedullary nail. The intramedullary nail in this study was the Surgical Implant Generation Network (SIGN) nail. Material and methods We enrolled patients desiring stature lengthening at the 108 Military Central Hospital (Hanoi, Vietnam) from October 2011 to January 2019. A total of 104 people have been enrolled in the study and underwent the bilateral tibial lengthening procedure. Results Average tibial lengthening was 7.1 +/- 0.8 cm in men and 6.5 +/- 0.6 cm in women. Percentage of tibial lengthening as compared with tibia length at the time of pre-operation was 23.9 +/- 3.5% for male patients and 21.5 +/- 3.7% for female patients. The outcome was excellent in 85 patients (81.7%) and good in 19 (18.3%). All patients experienced improved self-esteem and enhanced quality of life. Conclusion Our study suggests that bilateral tibial lengthening over nail was safe and effective provided complications are looked for and kept in check. Equinus contracture, pin tract infection, and valgus deviation were the most common complications. Valgus deviation occurs during distraction period. In patient who had neutral or valgus alignment, we recommend to use a blocking screw at the proximal segment post- operatively and use a blocking screw at the valgus distal segment at the end of distraction period to maintain the mechanical axis of both tibias. Bilateral tibial lengthening over nail should be widely employed in low-income countries.