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Prophylactic titanium elastic nailing (TEN) following femoral lengthening (Lengthening then rodding) with one or two nails reduces the risk for secondary interventions after regenerate fractures: a cohort study in monolateral vs. bilateral lengthening procedures

Frank Schiedel1*, Ulrich Elsner2, Georg Gosheger2, Björn Vogt1 and Robert Rödl1

Author Affiliations

1 Department of Children’s Orthopaedics, Deformity Correction and Foot Surgery, Münster University Hospital, Albert-Schweitzer-Campus 1, Münster, D-48149, Germany

2 Department of General Orthopaedics and Tumour Orthopaedics, Münster University Hospital, Albert-Schweitzer-Campus 1, Münster, D-48149, Germany

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BMC Musculoskeletal Disorders 2013, 14:302  doi:10.1186/1471-2474-14-302

Published: 25 October 2013



Femoral fracture rates of up to 30% have been reported following lengthening procedures using fixators. “Lengthening then rodding” uses one or two titanium elastic nails (TENs) for prophylactic intramedullary nailing to reduce this complication. The aim of the study was to decide if usage of only one TEN is safe or has it a higher risk of getting a fracture? And we asked if there is a difference between patients with monolateral or bilateral lengthening procedures according to their fracture rate?


One or two TENs were implanted in two groups of patients (monolateral and bilateral) after femoral lengthening procedures. The regenerate quality was classified using the Li system and fractures were categorized using the Simpson and Kenwright classification. The follow-up period was at least 1 year after removal of the frame.


Sixty-seven patients with 101 femoral lengthening procedures were included in 2007–2011. Group A included 34 patients with bilateral lengthening due to congenital short stature. Group B consisted of 33 patients with congenital disorders with leg length discrepancies. Seven fractures in six patients were seen in group A and five fractures in group B. One patient had residual shortening of 1 cm, and 11 fractures healed without relevant deviation (< 5°) or shortening (< 5 mm). A soft-tissue infection in one patient led to early removal of one TEN.


Fractures occurred in both groups of patients in total in 12 of the 101 cases (12%). The rate of secondary interventions was markedly reduced. Usage of one or two TENs did not influence the fracture rate.

Limb lengthening; Regenerate fracture; Lengthening then rodding; TENs nailing after lengthening; Callus pattern