Motorized Intramedullary Lengthening of the Tibia

The motorized internal lengthening nail (MILN) has revolutionized the ability to perform distraction osteogenesis without the use of circular external fixation. Lengthening of the tibia bone can be accomplished with great success using an MILN. Contraindications for the MILN in the tibia have traditionally been a small intramedullary canal and open proximal tibial growth plates. Tibia lengthening surgery with an internal implant faces the well-known challenges unique to lower leg lengthening with external fixation including the need to protect the syndesmotic joints, the risk of peroneal nerve stretch injury, the risk of compartment syndrome, and the propensity for valgus and flexion deformity. The use of blocking screws is very helpful in steering the bone and preventing deformity. The Ilizarov method has been expanded to include this new internal technology, but distraction osteogenesis by any method requires careful stewardship by the surgeon to ensure a safe experience and reliable outcome.