الفهرس 
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Abstract
This study is a retrospective systematic review including articles about lower limb lengthening by pure intramedullary distraction nails. It was searched in Cochrane Library and Medline (PubMed) of internet published articles for the most common intramedullary nails devices used and we compare four nails: PRECICE, FITBONE, ALBIZZA, and ISKD nails.
In this study, it was found 50 articles concerning lower limb lengthening of different etiologies, whatever, femoral or tibial lengthening or both in the study period between 2010 to 2019. We excluded half of this number due to different factors.
As regard to the demographic characteristics from the previous studies, it was cleared that males were more prominent than females and the mean age was observed in the middle-aged youth than in older patients. It was observed also that the most performed procedure was the Precice nail (235), then the Fitbone (123), followed by ISKD (99) and lastly the Albizza nail (64), which indicated that surgeon prefer the Precice nail of lower limb lengthening than other procedures.
This fact of less period of recovery was confirmed by the shorter follow-period in the Precice than Fitbone, Albizza and ISKD which was 15.14 ± 8.74, 23.88 ± 6.05, 34.70 ± 6.50, 51.00 ± 25.0 months, respectively.
However, femoral IMN lengthening was more performed than tibial nails (413/110, respectively). Precice nailing was performed in 191 cases with femoral nailing (mean ±SD, 15.9 ± 7.93) and 49 cases with tibial nailing (mean ±SD, 5.44 ± 1.16). Fitbone was performed in 103 cases with femoral nailing (mean ±SD, 14.7 ± 5.27) and 30 cases with tibial nailing (mean ±SD, 7.5 ± 3.5). Albizza was performed in 23 cases with femoral nailing (mean ±SD, 11.5 ± 3.5) and 11 cases with tibial nailing (mean ±SD, 5.5 ± 5.5). ISKD was performed in 96 cases with femoral nailing (mean ±SD, 32.0 ± 17.3) and 20 cases with tibial nailing (mean ±SD, 10.0 ± 1.0). It was found that highly statistical significance (P <0.001) in comparison between femoral and tibial nailing in the four procedures.
As regard limb length discrepancy (LLD) in the studied articles, with a mean of 3.86 ± 0.67 cm, 4.26 ± 0.59 cm, 8.14 ± 3.66 cm, 4.25 ± 0.302 cm in PRECICE, FITBONE, ALBIZZA, and ISKD, respectively. They showed a statistically insignificant difference (P >0.05). The mean achieved length was of 3.45 ± 0.86 cm, 4.37 ± 0.56 cm, 4.99 ± 0.46 cm, 4.13 ± 0.38 cm in PRECICE, FITBONE, ALBIZZA, and ISKD, respectively. They showed a statistically significant difference (P < 0.05).
The mean distraction period (days) in the studied procedures was 91.56 ± 32.4, 46.9 ± 14.4, 75.55 ± 1.45 in PRECICE, FITBONE, ALBIZZA, and ISKD, respectively. They showed a statistically significant difference (P <0.05). The mean distraction index (mm/day) was 1.01 ± 0.141, 0.96 ± 0.14, 1.2 ± 0.00, 1.41 ± 0.27 in PRECICE, FITBONE, ALBIZZA, and ISKD, respectively. They showed a statistically significant difference (P <0.05).
As regard the mean bone healing period (days), it was 124.5 ± 50.71, 209.9 ± 67.35, 236 ± 33.0, 162.5 ± 74.5 in PRECICE, FITBONE, ALBIZZA, and ISKD, respectively. They showed a statistically significant difference (P <0.05). The mean healing index (day/cm), it was 26.99 ± 5.94, 43.08 ± 13.69, 50.47 ± 15.02, 57.1 ± 33.8 in PRECICE, FITBONE, ALBIZZA, and ISKD, respectively. These showed a statistically highly significant difference (P <0.001) in comparison between Precice nail and the three other procedures, while the three other procedures did not show any significant difference between each other (P >0.05). This indicated that Precice nailing had a less days for healing than the other three procedures.
Variations of bone healing and bone healing index were explained by different factors affecting the healing process such as patients age, LLD and method of lengthening device used, and lastly the incidence of complications.
As regard side effects and complications, the most prominent rate of complications was observed in ISKD nailing (18.2%), followed by Precice (17.9%), then the Albizza procedure (14.1%) and the least complications were observed in Fitbone procedure (13%), however this ratio and nearly comparable and does not interfere with the type of procedure selection.