The name ISKD-Nagel is an acronym:
ISKD = I.ntramedullary S.keletal Kinetic D.istractor
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:
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.
A need to be Leg extension can be caused by various causes.
Reasons to perform a unilateral leg extension can be:
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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.
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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.
When can the ISKD - nail not be applied?
Advantages of the ISKD - nail:
Disadvantages of the ISKD - nail:
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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
