Automated 24-hour control of distraction forces: a new technology for limb lengthening

Introduction The classic Ilizarov technology of transosseous distraction osteosynthesis provides rigid fixation, accurate bone control in frontal and sagittal planes addressing all types of deformities and the limb length. Long-term Ilizarov fixation can be associated with adverse events and distraction forces are to be monitored. A  new technology for limb lengthening using automated 24-hour control of distraction force facilitates optimal rate of deformity correction and can reduce Ilizarov fixation when combined with intramedullary titanium pins with a bioactive coating.
The objective was to demonstrate continuous distraction force control technology in the correction of varus deformity of the tibia and anatomical lengthening.
Material and methods Simultaneous tibial lengthening and correction of tibial deformity was produced with a new automated distractor (patent RU No. 2763644) measuring forces of the external fixation device every time with the gearbox switching on.
Results and discussion Continuous distraction force control was well illustrated in an Ilizarov patient treated with combined distraction osteosynthesis. The use of the device was associated with a shorter bone consolidation time (IO = 15 days/cm) after sequential distraction osteosynthesis with genu varum eliminated and the bone lengthened.
Conclusion Dynamic distraction force control with a new automated device allowed for monitoring the lengthening process, identifying potential complications, adjusting the distraction rate, reducing osteosynthesis time by two to four times.

1. Feichtinger X, Kocijan R, Mittermayr R, et al. Fracture patterns in patients with multiple fractures: the probability of multiple fractures and the most frequently associated regions. Eur J Trauma Emerg Surg. 2020;46(5):1151-1158. doi: 10.1007/s00068-019-01087-4.

2. Shevtsov VI, Popkov AV. Distraction-Compression Osteosynthesis in Limb Elongation with the Ilizarov Apparatus. Traumatology and Orthopedics of Russia. 1995;(1):35-37. (In Russ.)

3. Dinah AF. Predicting duration of Ilizarov frame treatment for tibial lengthening. Bone. 2004;34(5):845-8. doi: 10.1016/j.bone.2004.01.026.

4. Kononovich NA, Popkov AV, Gorbach EN, Popkov DA. The effect of nanostructured hydroxyapatite coating on distraction osteogenesis. Key Engineering Materials. 2020;(854):216-222. doi: 10.4028/www.scientific.net/KEM.854.216.

5. Popkov AV, Gorbach ES, Mamedov UF, Stepanov RV. Tibial lengthening over a bioactive degradable intramedullary implant: a case report. Genij Ortopedii. 2023;29(6):645-649. doi: 10.18019/1028-4427-2023-29-6-645-649.

6. Stoddart JC, Dandridge O, Garner A, et al. The compartmental distribution of knee osteoarthritis - a systematic review and meta-analysis. Osteoarthritis Cartilage. 2021;29(4):445-455. doi: 10.1016/j.joca.2020.10.011.

7. Ogino T, Kumagai K, Yamada S, et al. Relationship between the bony correction angle and mechanical axis change and their differences between closed and open wedge high tibial osteotomy. BMC Musculoskelet Disord. 2020;21(1):675. doi: 10.1186/s12891-020-03703-6.

8. Kim JI, Kim BH, Han HS, Lee MC. Rotational Changes in the Tibia After High Tibial Valgus Osteotomy: A Comparative Study of Lateral Closing Versus Medial Opening Wedge Osteotomy. Am J Sports Med. 2020;48(14):3549-3556. doi: 10.1177/0363546520960114.

9. Schubert I, Ferner F, Dickschas J. The effect of open-wedge and closed-wedge high tibial osteotomies on the tibial posterior slope-a study of two hundred seventy-nine cases. Int Orthop. 2020;44(6):1077-1082. doi: 10.1007/s00264-020-04499-9.

10. Ji S, Gao Y, Zhang J, et al. High tibial lateral closing wedge and opening wedge valgus osteotomy produce different effects on posterior tibial slope and patellar height. Front Surg. 2023;10:1219614. doi: 10.3389/fsurg.2023.1219614.

11. Artemiev AA, Ivashkin AN, Kashoob AM, et al. Features of surgical treatment of posttraumatic lower limbs of different lengths in adult patients. Russian Sklifosovsky Journal Emergency Medical Care. 2020;9(4):573-579. doi: 10.23934/2223-9022-2020-9-4-573-579.

12. Feichtinger X, Kocijan R, Mittermayr R, et al. Fracture patterns in patients with multiple fractures: the probability of multiple fractures and the most frequently associated regions. Eur J Trauma Emerg Surg. 2020;46(5):1151-1158. doi: 10.1007/s00068-019-01087-4.

13. Shchepkina EA, Solomin LN, Sauta OI, Sabirov FK. Substantiation for the use of orthopedic hexapod for the femur lengthening over the nail. Department of Traumatology and Orthopedics. 2021;(3):27-36. (In Russ.) doi: 10.17238/issn2226-2016.2021.3.27-36.

14. Ilizarov GA, Predein AP, Bykov VM. Automatic compression-distraction apparatus. Patent US, no. 4,615,338. 1986. Available at: https://patentimages.storage.googleapis.com/df/60/66/d910996b4d41c8/US4615338.pdf. Accessed Oct 27, 2025.

15. Pursley JA, Holloway JM, Wakefield TL. Automatic compression-distraction-torsion method and apparatus. Patent US no. 4,973,331. 1990. Available at: https://patentimages.storage.googleapis.com/36/95/97/1622062a9a5d0b/US4973331.pdf. Accessed Oct 27, 2025.

16. Ilizarov GA, Ruts FYa, Nemkov VA, et al. Compression-distraction apparatus. Author's Certificate SU no. 1122308. 1984. Available at: https://patents.google.com/patent/SU1122308A1/en. Accessed Oct 27, 2025.

17. Shevtsov VI., Burlakov E.V., Nemkov V.A. Transosseous device. Patent RF for a utility model no. 30073. 2003. Available at: https://www.fips.ru/registers-doc-view/fips_servlet?DB=RUPM&DocNumber=30073&TypeFile=html. Accessed Oct 27, 2025. (In Russ.)

18. Shevtsov VI, Popkov AV, Popkov DA, Muradisinov SO. Elongation of lower limbs by an automatic mode. Genij Ortopedii. 1999;(3):20-24. (In Russ.)

19. Semkin AV, Piastro AE, Popkov AV, et al. Systemforcontrollingprocessofdistractionosteosynthesisbasedonfeedba ck withdistractionforcesinautomatedtransosseouscompression-distraction apparatus. Patent RF, no. 2833763, 2035. Available at: https://patentimages.storage.googleapis.com/c2/ac/2d/7c2820790e7a6f/RU2833763C1.pdf. Accessed Oct 27, 2025.

20. Popkov AV, Semkin AV, Popkov DA, et al. Transosseous automated distraction device and automatic transfer unit. Patent RF, no. 2763644 C1. 2021, Available at: https://www.fips.ru/registers-doc-view/fips_servlet?DB=RUPAT&DocNumber=2763644&TypeFile=html. Accessed Oct 27, 2025. (In Russ.)

21. Popkov AV, Popkov DA, Kononovich NA, et al. Osteoperfusion of bioactive implants in the treatment of fractures of long tubular bones: a study guide. Tomsk: Publ. House of Tomsk Polytechnic University; 2017:84-103. (In Russ.)

22. Popkov AV, Popkov DA. Bioactive Implants in Traumatology and Orthopedics. Irkutsk: NCRVH SO RAMS, 2012:127-177. (In Russ.)

23. Shevtsov VI, Popkov AV. Operative Lengthening of the Lower Extremities. Moscow: Meditsina Publ.; 1998:89-171. (In Russ.)

24. Popkov AV, Gorodtsov NA, Popkov DA, et al. Automation of Operative Limb Lengthening (Literature Review). Medical Technology. 2024; 348(6):49-53. (In Russ.)

25. Popkov AV, Popkov DA, Kononovich NA, et al. Limb elongation under conditions of bioactive implantation in long tubular bones: a textbook. Tomsk: Publ. House of Tomsk Polytechnic University; 2018:60-121. (In Russ.)