Intramedullary distraction for lower limb lengthening

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 12 sources, which was discussed by the committee. The evidence included 5 systematic reviews, 2 retrospective cohort studies, 2 case series, 1 retrospective matched case series, 1 cross-sectional study and 1 case report. 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.

The professional experts and the committee considered the key efficacy outcomes to be: achievement of target limb length, improved function and improved quality of life.

The professional experts and the committee considered the key safety outcomes to be: pain, infection, device related complications, and delayed or non-union.

Patient commentary was sought but none was received.

The committee noted that:

• the technology used for limb lengthening is evolving and external fixator use has become less common

• there are several devices available for use in this procedure, and they may have different efficacy and safety profiles

• assessing and managing the soft tissues is key to successful outcomes.

The committee was informed that some people with short stature have had bilateral limb lengthening using this technique. However, no evidence of benefit for this indication was reviewed by the committee, so this guidance is not intended to cover it.

The committee encourages the establishment of a registry for this procedure.