Table 9.

Review of studies using the ISKD

Study	Type of study	Number of limbs	Average followup	Mean amount lengthened	Treatment duration	Complications	Conclusions
Kenawey et al. [11]	Retrospective	57 (45 femora, 12 tibiae)	23 months	4.3 cm	Healing index 1.2 months/cm	Superficial wound infection (n = 1), premature consolidation (n = 4) and insufficient bone regenerate (n = 11), nine runaway nails and three nondistracting nails	Distraction rates greater than 1.5 mm/day cause insufficient bone regenerate; distraction problems mostly the result of dysfunction in the ratcheting mechanism, which may be related to the diameter of the nail
Simpson et al. [26]	Retrospective	33	18 months	46 mm	–	Difficulty in achieving length (n = 8 [24%]), uncontrolled lengthening (n = 7 [21%]), refracture (n = 1 [3%]), and implant failure (n = 2 [6%])	Uncontrolled lengthening was more likely if the osteotomy was placed with less than 80 mm of the thick portion of the nail in the distal fragment, and failure to lengthen was more likely if there was greater than 125 mm in the distal fragment
Kubiak et al. [14]	Retrospective	11	16 months	3.1 cm	Nails removed mean 11.5 months	Seven required additional surgery (four failures to advance requiring reosteotomy; three premature consolidations requiring osteoclasis)	Binding at the osteotomy site was responsible for failure of nail advancement in patients in whom lengthening failed
Hankemeier et al. [6]	Prospective	Four (three femora, one tibia)	14 months	31 mm	Average consolidation index of 29 days/cm	–	Well-tolerated procedure without the complications associated with external fixation
Cole et al. [4]	Retrospective	20 (six femora, 14 tibiae)	–	4.9 cm	Average lengthening rate 0.82 mm/day	Two hardware failures	Appears to be a safe and cost-effective alternative to external fixators

ISKD = Intramedullary Skeletal Kinetic Distractor (Orthofix Inc, McKinney, TX, USA).