Lower limb lengthening: is there a difference in the lengthening index and infection rates of lengthening with external fixators, external fixators with intramedullary nails or intramedullary nailing alone? A systematic review of the literature

A review of the current literature was undertaken to assess the lengthening index (LI) and infection rates found with different techniques of lower limb lengthening. We compared three methods of lengthening: external fixators, intramedullary nails and both methods used as a combined technique. Ten papers meeting the inclusion criteria were reviewed. The review found that by using either an ExFix with IMN or an IMN alone lengthening was achieved at twice the rate of ExFix alone. There were no infections recorded in the IMN group, 36.2% superficial and 2.5% deep in the ExFix group and 1.4% superficial and 5.5% deep in the ExFix + IMN group. When using LI and infection rates to compare techniques, the safest and most effective method of lower limb lengthening appears to be with IMN alone.