Acute Deformity Correction and Lengthening with Motorized Nail: Surgical Technique

Limb deformity with associated limb length inequality results from many causes and can lead to significant morbidity. Internal motorized nails have revolutionized the field of limb lengthening and allow for concomitant correction of deformity and limb length inequality without the use of external fixation. These devices can be used in many adult and pediatric cases, although care must be taken to assure that successful reconstruction without contraindications is possible. Planning for an optimal outcome with these devices requires careful preoperative planning and attention to a number of technical points not typical of other treatment strategies. We also present a novel osteotomy method, the “comminuted closing wedge osteotomy,” that we have found to be beneficial in allowing for correction of larger magnitudes of deformity than would otherwise be possible and with notably improved regenerate bone formation when performing large angular corrections. Internal motorized nails combined with appropriate planning, an optimal osteotomy, appropriately placed stabilization screws, and soft tissue management offer an exciting and powerful advance in our ability to treat combined long bone deformity and shortening.