Dataset Information

Complications and risk factors of intramedullary bone lengthening nails: a retrospective multicenter cohort study of 314 FITBONE and PRECICE nails.

ABSTRACT:

Background and purpose

Intramedullary bone-lengthening nails have become increasingly popular. The 2 most used and successful nails are the FITBONE and the PRECICE nails. Uniform reporting is lacking on complications of intramedullary bone-lengthening nails. The purpose was therefore to assess and categorize the complications of lower limb bone-lengthening nails and investigate risk factors.

Patients and methods

We performed a retrospective review of patients operated on with intramedullary lengthening nails at 2 hospitals. We included only lower limb lengthening with FITBONE and PRECICE nails. Recorded patient data was patient demographics, nail information, and any complication. Complications were graded according to severity and origin classification. Complication risk factors were assessed with modified Poisson regression.

Results

314 segments in 257 patients were included. The FITBONE nail was predominantly used (75%), and most of the lengthenings were performed in the femur (80%). 53% of the patients had complications. 269 complications were identified in 175 segments (144 patients). Device-related complications were most frequent (0.3 complications/segment), followed by joint complications (0.2 complications/segment). An increased relative risk was found for complications in the tibia compared with the femur and for age groups above 30 years compared with the 10-19 years group.

Conclusion

Complications with intramedullary bone lengthening nails were more frequent than has previously been reported, with 53% of patients sustaining a complication. Future studies need to document the complications meticulously so that the true risk can be established.

SUBMITTER: Frost MW

PROVIDER: S-EPMC9940487 | biostudies-literature | 2023 Feb

REPOSITORIES: biostudies-literature

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Publications

Complications and risk factors of intramedullary bone lengthening nails: a retrospective multicenter cohort study of 314 FITBONE and PRECICE nails.

Frost Markus W MW Rahbek Ole O Iobst Christopher C Bafor Anirejuoritse A Duncan Molly M Kold Søren S

Acta orthopaedica 20230217

<h4>Background and purpose</h4>Intramedullary bone-lengthening nails have become increasingly popular. The 2 most used and successful nails are the FITBONE and the PRECICE nails. Uniform reporting is lacking on complications of intramedullary bone-lengthening nails. The purpose was therefore to assess and categorize the complications of lower limb bone-lengthening nails and investigate risk factors.<h4>Patients and methods</h4>We performed a retrospective review of patients operated on with intr ...[more]

PMID: 36807707

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Project description:IntroductionPRECICE intramedullary magnetic lengthening nails, introduced in 2011, have changed the landscape of long bone limb lengthening. The implants have a stroke ranging from 5 to 8 cm, but it may be desirable to perform part of the lengthening at one treatment, allow bone healing, leave the implant in place, dormant, and then return one or more years later to re-lengthen with the same implant. We call this the "sleeper" nail concept. This strategy may be gentler for the joints and soft tissues. Would the nail mechanism still be functional one or more years later?MethodsWe tested 102 intact, consecutively explanted nails. Using a "fast magnet," the male part was lengthened to 5 mm short of its maximum stroke capacity and retracted back to 35 mm (all nails start with the male part exposed 30 mm). The nails passed the test if the male part succeeded in lengthening to 5 mm short of the maximum stroke capacity and back to 35 mm (or only retract in case fully deployed at testing). During our testing, the nails were prevented from reaching their full capacity of lengthening/retraction to avoid jamming the gears. Failure was defined as the inability or partial ability to complete the process.ResultsEighty-six nails (84.3%) performed successfully according to our testing standard. When comparing successful and failed nails in terms of nail type, generation, diameter, length and in vivo interval, there was no statistical significance. Comparing both groups in terms of status at testing (fully deployed or not) showed statistical significance with 9 of the 16 failed nails fully deployed at testing (p < 0.001).ConclusionDormant PRECICE nails can be reactivated for further lengthening. The results imply that full deployment may damage the mechanism, making future re-use by retracting and then re-lengthening unsuccessful. The candidate nails for this purpose should not have any signs of clear damage (bending or breakage) and should not have been fully deployed. However, surgeons and patients should be aware of the need for possible nail exchange if the "sleeper" nail fails to wake up.Level of evidenceLevel IV case series analysis of retrieved surgical implants.

Project description:BackgroundDifferent types of external fixators have been used for humeral lengthening with successful outcomes reported in literature. Motorized intramedullary (IM) lengthening nails have been developed as an alternative to external fixators for long bone lengthening in the lower extremity.Questions/purposesThis case series reports on using the new technology of IM lengthening nails for humeral lengthening. We assessed the radiological healing and functional outcomes after using the PRECICE IM nail for humeral lengthening.MethodsThis multicenter retrospective study included a total of six humeri in five patients (mean age was 20 years) that underwent lengthening with the magnetic IM PRECICE nail in two centers in the USA. The etiology was humeral growth arrest post-bone cyst (two segments), post-septic growth arrest (two segments), and multiple hereditary exostosis (bilateral segments in one patient). The outcomes measured were the length achieved, distraction index (DI; the length achieved in mm divided by the duration of lengthening in days), consolidation index (CI; number of days from surgery until consolidation divided by the length of the regenerate in cm), complications encountered, and functional outcomes (shoulder and elbow range of motion, the upper extremity functional index (UEFI), and QuickDASH functional scores).ResultsThe mean follow-up period was 1.8 years (0.9 to 2.4 years). All segments achieved the goal of lengthening; the mean was 5.1 cm (4.5 to 5.8 cm). Mean DI was 0.7 mm/day (0.5 to 0.8). Mean CI was 36 days/cm (25 to 45 days/cm). No complications were observed. At the last follow-up, all patients maintained their preoperative range of motion (ROM) except one patient had reduced shoulder ROM. QuickDASH score and upper extremity functional index showed postoperative improvement compared to the preoperative scores.ConclusionIM lengthening nails can provide successful and safe humeral lengthening. Specifically, the PRECICE nail has accurate control over the lengthening process.

Project description:IntroductionMagnetic internal lengthening nails (MILNs) have been used for femoral lengthening to avoid complications associated with external fixation. The titanium version of the MILN (PRECICE®) has been in use since 2011 but had limitations (50-75 lb) in post-operative weight bearing. A new stainless-steel version of the MILN (STRYDE®) allows 150-250 lb of post-operative weight bearing. The aim is to compare the outcomes of using these two different MILNs for both unilateral and bilateral femoral lengthening.MethodsA single-center, retrospective cohort study was conducted in which patients' records were reviewed from the period from January 2017 to March 2020. A total of 66 femoral lengthening procedures were included in the study and were divided into two groups: STRYDE® group (30 femora) and PRECICE® group (36 femora). Outcomes assessed were the 6-months post-operative Limb Deformity-Scoliosis Research Society (LD-SRS) Score, adjacent joint range of motion (ROM), average distraction rate, bone healing index (BHI), and complications.ResultsNo statistically significant difference was found between the two groups in regard to the (LD-SRS) score, hip ROM, or knee ROM. Statistically significant differences were found between the two groups in regard to BHI (average of 0.84 months/cm and 0.67 months/cm for STRYDE® and PRECICE®, respectively) and distraction rate (average of 0.6 mm/day and 0.9 mm/day for STRYDE® and PRECICE®, respectively). No mechanical nail complications were reported in the STRYDE® group compared to three events of nail failure in the PRECICE® group. One femur in the PRECICE® group needed BMAC injection for delayed healing compared to four femurs in the STRYDE® group.ConclusionThe STRYDE® MILN yields comparable functional results to those of PRECICE® MILN and shows fewer mechanical nail complications. However, STRYDE® MILN requires a slower distraction rate and yields slower healing (larger BHI).Level of evidenceLevel III, Therapeutic study.

Dataset Information

Complications and risk factors of intramedullary bone lengthening nails: a retrospective multicenter cohort study of 314 FITBONE and PRECICE nails.

Background and purpose

Patients and methods

Results

Conclusion

Publications

Complications and risk factors of intramedullary bone lengthening nails: a retrospective multicenter cohort study of 314 FITBONE and PRECICE nails.

Similar Datasets

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