ISKD - nail
Synonyms in a broader sense
- Extension nail
- Callus distraction
- post-traumatic leg shortening
- Leg extension
- Extension nail
- Leg length difference
The name ISKD
The name ISKD-Nagel is an acronym:
ISKD = I.ntramedullary S.keletal Kinetic D.istractor
introduction
The therapy of one-sided leg shortening using ISKD nail posed tibial (tibia side) as well as on femoral (thigh side) poses a major surgical challenge.
Bony distractions (Extension) were only possible with external fixators (see picture below) until the beginning of the nineties. At external fixators it is a metallic frame that while in the extension the bone support from the outside.
These fixators are particularly characterized by:
- so-called PIN infections (infections in the area where the metal leaves the bones and skin)
- Loss of correction (change in result if the external fixator is removed again)
- insufficient callus formation (lack of bone healing)
and - Refractures (new fractures)
Furthermore, bulky fixators significantly limit the quality of life. For this reason, alternatives were sought. As part of the development of so-called intramedullary osteosynthesis (e.g. nailing in the hollow area of the long bone), the application was also in the area of Callus distraction (Bone lengthening) possible.
Under one intramedullary osteosynthesis is a (bone) nail that is pushed through the long bone and splinters the bone from the inside.
One of the furthest developments in this area is that ISKD - nail.
indication
A need to be Leg extension can be caused by various causes.
Reasons to perform a unilateral leg extension can be:
- congenital shortening of the legs
- post-traumatic (accident-related) leg shortening
Appointment with ?
I would be happy to advise you!
Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
But now enough is indicated ;-)
In order to be able to treat successfully in orthopedics, a thorough examination, diagnosis and a medical history are required.
In our very economic world in particular, there is too little time to thoroughly grasp the complex diseases of orthopedics and thus initiate targeted treatment.
I don't want to join the ranks of "quick knife pullers".
The aim of any treatment is treatment without surgery.
Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.
You will find me:
- Lumedis - orthopedic surgeons
Kaiserstrasse 14
60311 Frankfurt am Main
You can make an appointment here.
Unfortunately, it is currently only possible to make an appointment with private health insurers. I hope for your understanding!
For more information about myself, see Lumedis - Orthopedists.
Extension principle
A bone cannot be lengthened by several centimeters in one step. The reason for this is that the bones must end up touching in order to reunite.
To solve this problem, the ISKD nail uses the so-called Callus distraction.
This is a slow but continuous elongation of the bone. By in the slow lengthening of the bone, in an area of during the surgery is deliberately severed.
Due to the continuous lengthening, the extended stretch can constantly regenerate in the fracture healing.
At the ISKD nail it is an implant which is inserted into the long bones of Shin and Thigh bone can be implanted.
The extension nail is constructed in such a way that two nails that can be moved into one another can extend one another.
The distraction (elongation) is after Ratchet principle triggered, by 3 ° alternating (mutual) rotation the nail is elongated by a fraction of a millimeter.
160 rotational movements result in 1 mm distraction (daily desired extension goal).
The Control of the extension takes place via a Magnetswhich is attached to the lower end of the inner rod of the nail and is measured five times a day via an external monitor.
The ISKD nail is extended until the desired extension has been achieved.
The extension is given to the nail. This means that the maximum extension of the ISKD nail is set and when the nail has lengthened to the maximum it cannot lengthen any further.
The disadvantage of this procedure is that after the implantation of the Extension nail is extended up to the specified extension target and can no longer be influenced.
Good results are in an extension range of three to five cm achieved. The maximum possible extension distance with this ISKD nail is 8 cm. But that too Tendons, annoy and muscle If you have to stretch at the same time, considerable problems arise with increasing elongation.
Contraindications
When can the ISKD - nail not be applied?
- Open growth joints
- Insufficient inner medullary canal diameter of the long bone
- Lack of patient cooperation
- Boil / soft tissue infections
- Atrophic pseudarthroses (non-healing fractures)
- Pronounced malpositions
Advantages of the ISKD nail
Advantages of the ISKD - nail:
- Overall less stressful than external procedures (patient comfort)
- Early loading capacity through splinting the long bones
- Accelerated rehabilitation
- no risk of stopping treatment, under which nail cannot be removed
- little scarring
- Less tendency to form deformities
Disadvantages of the ISKD nail
Disadvantages of the ISKD - nail:
- Good co-workers whose patients require regular control of the extension of the nail
- Daily varying extension distance (depending on daily movement)
- It is not possible to change the distraction speed
- It is not possible to shorten the implant
Problems of the ISKD nail
- Daily varying distraction distance (depending on daily movement)
- Premature bone healing
- Inadequate elongation due to excessive pain
- Too fast extension (inform the patient, if necessary a thigh cast)
- Failure to heal the fracture
Result
Final information
A total of approx. 700 ISKD nails have been implanted so far (120 in Germany, 220 in Europe and approx. 460 in the USA)
The total price per nail is approx. € 9,400, plus surgery and follow-up treatment costs.
Costs are covered by private health insurances, in the case of statutory health insurance patients only after individual negotiation
