Intramedullary distraction for upper limb lengthening
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3 Committee considerations
The evidence
3.1 NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 2 sources, which was discussed by the committee. The evidence included 2 retrospective case series. It is presented in the summary of key evidence section in the interventional procedures overview. Other relevant literature is in the appendix of the overview.
3.2 The professional experts and the committee considered the key efficacy outcomes to be: achievement of target limb length, patient-reported outcomes, improved function and quality of life.
3.3 The professional experts and the committee considered the key safety outcomes to be: infection, pain, joint stiffness, device-related complications, and delayed or non-union.
3.4 Patient commentary was sought but none was received.
Committee comments
3.5 The committee noted that there is more than 1 device available for this procedure.
3.6 The committee was informed that postoperative physiotherapy is essential for muscle strengthening and functional recovery.
3.7 The committee was informed that it is important to carefully control the rate of limb lengthening to reduce the risk of damage to muscles, joints and nerves.
3.8 The committee noted that this is a rare condition and that alternative treatment options are limited.
Tom Clutton-Brock
Chair, interventional procedures advisory committee
October 2021
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