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Dubin JA, Bains SS, Moore M, Assayag MA, McClure PK. Outpatient limb lengthening using magnetic intramedullary nails: A single Institution's experience. J Orthop 2024; 53:163-167. [PMID: 38601890 PMCID: PMC11002844 DOI: 10.1016/j.jor.2024.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/12/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction The advantages of outpatient surgery have been shown in other orthopedic subspecialities to be a means of driving down costs and reducing the average length of hospital stay. However, there is a scarcity of literature examining the utility of a specific, hospital-based facility performing such procedures for limb lengthening. Considering this, we aimed to investigate surgical factors, patient characteristics, and the incidence of outpatient postoperative complications for patients undergoing surgery and subsequent distraction osteogenesis utilizing the Precice® nail, a state-of-the-art magnetic intramedullary nail (MILN). Methods We performed a retrospective review of medical records pertaining to outpatient limb lengthening procedures occurring between January 2012 and September 2023 at a single institution, as performed by three surgeons. Variables of interest included baseline demographics, type of anesthesia, operative bone, laterality, preoperative diagnosis, osteotomy level, procedure performed, prosthesis, point of entry, nail diameter/length, goal length, goal achieved, postoperative complications, and elective nail removal. Results The cohort comprised 20 limbs, with an average age at index surgery of 24.8 (SD 7.96). There were no complications related to the outpatient nature of the procedure. Five of the 20 limbs had postoperative complications, including deep vein thrombosis (DVT), screw backout, and nail breakage. Conclusion Our initial investigation of outpatient limb lengthening at a specific, hospital-based facility demonstrated favorable postoperative outcomes for those patients undergoing limb lengthening procedures with an MILN. The field would certainly benefit from future research assessing outcomes of pediatric surgeries in the outpatient setting on a larger scale, as well as across hospital systems, the country, and globally. With the proven advances and benefits of MILNs, prioritizing examination of their efficacy in an outpatient population is imperative. Furthermore, the success of outpatient procedures in other orthopedic subspecialities, such as total joint arthroplasty, is a logical, driving precedent for this rationale.
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Affiliation(s)
- Jeremy A. Dubin
- Lifebridge Health Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Sandeep S. Bains
- Lifebridge Health Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Mallory Moore
- Lifebridge Health Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Michael A. Assayag
- Lifebridge Health Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Phillip K. McClure
- Lifebridge Health Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
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Lee WG, Evans LL, Harrison MR. Beyond the gut: spectrum of magnetic surgery devices. Front Surg 2023; 10:1253728. [PMID: 37942002 PMCID: PMC10628496 DOI: 10.3389/fsurg.2023.1253728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/06/2023] [Indexed: 11/10/2023] Open
Abstract
Since the 1970s, magnetic force has been used to augment modern surgical techniques with the aims of minimizing surgical trauma and optimizing minimally-invasive systems. The majority of current clinical applications for magnetic surgery are largely centered around gastrointestinal uses-such as gastrointestinal or bilioenteric anastomosis creation, stricturoplasty, sphincter augmentation, and the guidance of nasoenteric feeding tubes. However, as the field of magnetic surgery continues to advance, the development and clinical implementation of magnetic devices has expanded to treat a variety of non-gastrointestinal disorders including musculoskeletal (pectus excavatum, scoliosis), respiratory (obstructive sleep apnea), cardiovascular (coronary artery stenosis, end-stage renal disease), and genitourinary (stricture, nephrolithiasis) conditions. The purpose of this review is to discuss the current state of innovative magnetic surgical devices under clinical investigation or commercially available for the treatment of non-gastrointestinal disorders.
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Affiliation(s)
- William G. Lee
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Lauren L. Evans
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Michael R. Harrison
- Department of Surgery, University of California San Francisco, San Francisco, CA, United States
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Lin S, Maekawa H, Moeinzadeh S, Lui E, Alizadeh HV, Li J, Kim S, Poland M, Gadomski BC, Easley JT, Young J, Gardner M, Mohler D, Maloney WJ, Yang YP. An osteoinductive and biodegradable intramedullary implant accelerates bone healing and mitigates complications of bone transport in male rats. Nat Commun 2023; 14:4455. [PMID: 37488113 PMCID: PMC10366099 DOI: 10.1038/s41467-023-40149-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 07/12/2023] [Indexed: 07/26/2023] Open
Abstract
Bone transport is a surgery-driven procedure for the treatment of large bone defects. However, challenging complications include prolonged consolidation, docking site nonunion and pin tract infection. Here, we develop an osteoinductive and biodegradable intramedullary implant by a hybrid tissue engineering construct technique to enable sustained delivery of bone morphogenetic protein-2 as an adjunctive therapy. In a male rat bone transport model, the eluting bone morphogenetic protein-2 from the implants accelerates bone formation and remodeling, leading to early bony fusion as shown by imaging, mechanical testing, histological analysis, and microarray assays. Moreover, no pin tract infection but tight osseointegration are observed. In contrast, conventional treatments show higher proportion of docking site nonunion and pin tract infection. The findings of this study demonstrate that the novel intramedullary implant holds great promise for advancing bone transport techniques by promoting bone regeneration and reducing complications in the treatment of bone defects.
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Affiliation(s)
- Sien Lin
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Hirotsugu Maekawa
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Seyedsina Moeinzadeh
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Elaine Lui
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA
- Department of Mechanical Engineering, School of Engineering, Stanford University, Stanford, CA, 94305, USA
| | - Hossein Vahid Alizadeh
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Jiannan Li
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Sungwoo Kim
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Michael Poland
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, 80523, USA
| | - Benjamin C Gadomski
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, 80523, USA
| | - Jeremiah T Easley
- Preclinical Surgical Research Laboratory, Department of Clinical Sciences, Colorado State University, Fort Collins, CO, 80523, USA
| | - Jeffrey Young
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Michael Gardner
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - David Mohler
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - William J Maloney
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Yunzhi Peter Yang
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA.
- Department of Materials Science and Engineering, School of Engineering, Stanford University, Stanford, CA, 94305, USA.
- Department of Bioengineering, School of Medicine, Stanford University, Stanford, CA, 94305, USA.
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Quesada A, Videla Ávila F, Horué Pontoriero G, Filisetti JE. Transporte sobre clavo respetando la membrana de Masquelet en defectos segmentarios severos. Serie de casos. REVISTA DE LA ASOCIACIÓN ARGENTINA DE ORTOPEDIA Y TRAUMATOLOGÍA 2023. [DOI: 10.15417/issn.1852-7434.2023.88.1.1570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Introducción: El adecuado tratamiento de los defectos óseos se presenta como un desafío para el cirujano ortopedista, en cuanto a la dificultad en la restitución de un miembro alineado, sin discrepancia ni infección. Se han descrito múltiples técnicas para reconstruir estos defectos, como el injerto óseo autólogo o de banco, la técnica de membrana inducida, la osteogénesis por distracción y los cilindros de titanio trabecular, pero ninguna ha demostrado ser significativamente superior a otra.
Materiales y Métodos: Entre 2018 y 2021, 10 pacientes con defectos óseos de la tibia fueron tratados mediante transporte óseo guiado con osteosíntesis endomedular. Se realizó un estudio retrospectivo descriptivo analizando la magnitud de los defectos, el tiempo de transporte, las complicaciones y cirugías adicionales durante el proceso, si hubo consolidación y las deformidades residuales. Al final del proceso, se midió el puntaje de la ASAMI (óseo y funcional).
Resultados: La longitud promedio de los defectos tratados fue de 9,75 cm y el índice de fijación externa promedio, de 40,62 días/cm. El 50% tenía un puntaje de la ASAMI óseo bueno; el 10%, excelente y el 40%, pobre al final del proceso reconstructivo. El 20% tenía un puntaje de la ASAMI funcional excelente; el 30%, bueno y el 50%, pobre.
Conclusiones: El uso de tutores externos guiados mediante osteosíntesis es un método fiable para tratar defectos óseos, al mismo tiempo que se trata la infección de manera local y sistémica, acortando los tiempos de tutor externo y, por lo tanto, de internación y reintervención.
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Preliminary Results of Bone Lengthening over Telescopic Titanium Intramedullary Rod. Case Rep Orthop 2023; 2023:4796006. [PMID: 36756206 PMCID: PMC9902136 DOI: 10.1155/2023/4796006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 12/04/2022] [Accepted: 12/29/2022] [Indexed: 01/31/2023] Open
Abstract
Background Limb lengthening and deformity correction in patients with abnormal bone associating fragility often require an approach combining methods of external and internal fixation. This study demonstrates results of simultaneous application of external fixator, and telescopic rod for femoral lengthening and deformity correction in three children with osteogenesis imperfecta or severe form of Ollier's disease. Materials and Methods Three patients (two boys with Ollier's disease and a girl with osteogenesis imperfecta, type I) were operated on for femoral lengthening with combined technique associating Ilizarov frame and titanium telescopic intramedullary rodding. Results Planned amount of lengthening and deformity correction were achieved for all patients. We found neither rod bending nor pull out of threaded tips. There was no difficulty of expanding of telescopic intramedullary rods made of titanium alloy during distraction phase of lengthening procedure. Conclusion This short series proved feasibility of performing one-stage surgery with external frame and telescopic rodding in limb lengthening. The technique of telescopic rods in lengthening procedure is promising method requiring meticulous insertion of rod in centralized positioning in epiphysis. Acute alignment of the segment been elongating should be achieved at surgery. No any progressive angular deformity correction in postoperative period is authorized in order to avoid bending of telescopic rod. This combined approach does not affect bone healing.
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Hafez M, Nicolaou N, Offiah A, Obasohan P, Dixon S, Giles S, Madan S, Fernandes JA. How Much Does Paediatric Femoral Lengthening Cost? A Cost Comparison between Magnetic Lengthening Nails and External Fixators. Strategies Trauma Limb Reconstr 2023; 18:16-20. [PMID: 38033930 PMCID: PMC10682557 DOI: 10.5005/jp-journals-10080-1573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 01/23/2023] [Indexed: 12/02/2023] Open
Abstract
Aim Motorised intramedullary lengthening nails are considered more expensive than external fixators for limb lengthening. This research aims to compare the cost of femoral lengthening in children using the PRECICE magnetic lengthening nail with external fixation. Methods Retrospective analysis of 50 children who underwent femoral lengthening. One group included patients who were treated with PRECICE lengthening nails, the other group included patients who had lengthening with external fixation. Each group included 25 patients aged between 11 and 17 years. The patients in both groups were matched for age. Cost analysis was performed following micro-costing and analysis of the used resources during the different phases of the treatments. Results Each group's mean patient age was 14.7 years. Lengthening nails were associated with longer operative times compared with external fixators, both for implantation and removal surgery (p-values of 0.007 and < 0.0001, respectively). Length of stay following the implantation surgery, frequency of radiographs and frequency of outpatient department appointments were all lower with lengthening nails. The overall cost of lengthening nails was £1393 more than external fixators, however, this difference was not statistically significant (p-value = 0.088). Conclusion The difference in the mean costs between femoral lengthening with lengthening nails versus external fixators was not statistically significant. Further research to review the effectiveness of the devices and the quality of life during the lengthening process is crucial for robust health economic evaluation. How to cite this article Hafez M, Nicolaou N, Offiah A, et al. How Much Does Paediatric Femoral Lengthening Cost? A Cost Comparison between Magnetic Lengthening Nails and External Fixators. Strategies Trauma Limb Reconstr 2023;18(1):16-20.
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Affiliation(s)
- Mohamed Hafez
- Department of Paediatric Trauma and Orthopaedic, Sheffield Children's Hospital, Sheffield, England, United Kingdom
| | - Nicolas Nicolaou
- Department of Paediatric Trauma and Orthopaedic, Sheffield Children's Hospital, Sheffield, England, United Kingdom
| | - Amaka Offiah
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Phillips Obasohan
- Department of Medical Statistics, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Simon Dixon
- Department of Health Economics and Decision Science, School of Health and Related Research, Sheffield, United Kingdom
| | - Stephen Giles
- Department of Trauma and Orthopaedics, Sheffield Children's Hospital, Sheffield, England, United Kingdom
| | - Sanjeev Madan
- Department of Paediatric Limb Reconstruction, Sheffield Children's Hospital NHS Trust, Sheffield, England, United Kingdom
| | - James Alfred Fernandes
- Department of Trauma and Orthopaedics, Sheffield Children's Hospital, Sheffield, England, United Kingdom
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Calder PR, Wright J, Goodier WD. An update on the intramedullary implant in limb lengthening: A quinquennial review Part 1: The further influence of the intramedullary nail in limb lengthening. Injury 2022; 53 Suppl 3:S81-S87. [PMID: 35768325 DOI: 10.1016/j.injury.2022.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/17/2022] [Accepted: 06/19/2022] [Indexed: 02/02/2023]
Abstract
The goal of limb lengthening is to restore length to bone, safely stretch soft tissues and improve quality of life with minimal complications. Traditionally this was achieved with the use of external fixators, associated with complications related to pin site tethering and infections, joint stiffness and regenerate deformity and fracture following frame removal. The duration of treatment also impacts on patient mental health and well-being. In order to reduce external fixator time, intramedullary nails have been introduced as an adjunct, either at the initial surgery or after completion of lengthening. Complications related to the external fixator still remained and innovation has led to the popularisation of the intramedullary lengthening nail. The lengthening mechanism of the nail can be divided into those with ratchet systems and those driven by motors. In the ratchet group, patients are required to manually rotate their limb, with movement at the osteotomy site, in order to create forward movement. This was often associated with pain, and in some cases led to the requirement of general anaesthesia to enable rotation and continuation of lengthening. Further issues were reported related to lengthening rate control. Once the nail had lengthened sufficiently for the osteotomy to disengage, rapid lengthening termed a 'runaway' nail could occur. The nails were limited to forward movement, and once length was gained it could not be retracted, leading to poor regenerate formation and soft tissue contractures. The introduction of the Fitbone implant utilised a transcutaneous electrical conduit, powered by a high frequency electrical signal, enabling more control over the lengthening. The Precice intramedullary lengthening system is controlled by the use of an external device with two rotating neodymium magnets, which produce rotation of a third magnet in the nail. By altering the direction of the magnet rotation, the lengthening can be controlled both forwards and backwards with sub-millimetre precision. Following initial excellent outcomes published, the use of the lengthening intramedullary nail has become accepted by many as the implant of choice in limb lengthening. The aim of this article comes in two parts. The first to highlight the latest research and clinical results in the last five years using an intramedullary implant during limb lengthening, and the second to report the outcome in extended surgical indications and further implant innovation.
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Affiliation(s)
- Peter R Calder
- The Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK.
| | - Jonathan Wright
- The Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
| | - W David Goodier
- The Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
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Gigi R, Hemo Y, Danino B, Ovadia D, Segev E. Changes in the femoral osteotomy level coefficient and neck shaft angle during limb lengthening with an intramedullary magnetic nail. Arch Orthop Trauma Surg 2022; 142:1739-1742. [PMID: 33555401 DOI: 10.1007/s00402-020-03740-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 12/19/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The intramedullary magnetic IM nail enables bone graduated distraction. Proximal femur osteotomies for ante grade IM lengthening nails have a tendency towards varus-procurvatum malalignment. We examined the effect of the level of the osteotomy and of trochanteric versus piriformis entry points on the neck shaft angle (NSA) during lengthening with the PRECICE IM magnetic nail. METHODS A novel parameter, the osteotomy level coefficient (OLC), was introduced as a guide to determine the level of an osteotomy at the proximal femur. The OLC was defined as the ratio between the distances from the tip of the greater trochanter to the osteotomy divided by the full length of the femur. A retrospective review of all femoral lengthening procedures with the PRECICE ante grade IM lengthening nail between 2013 and 2018 was carried out. RESULTS 31 femurs were lengthened in 30 patients (16 males and 14 females, mean age at surgery years 17.1. The average amount of lengthening was 4.4 cm. Trochanteric entry points were used in 24 femurs, and piriformis entry points in seven femurs. The OLC values ranged from 0.16 to 0.34 (average 0.25). The average follow-up period was 10.15 months. The distraction index average 10.5 days/cm (Range 8.6-11.9), Consolidation index 32.1 days/cm (14.3-51.9). The average post-operative NSA was significantly reduced from 133.5º to 128.5º [t (31) = 5.57, p = 0.000]. There was no correlation between the OLC and the change in the NSAs. The trochanteric entry point showed a greater tendency to reduce the NSA (Mdif = - 6, SD = 4.8) compared to the piriformis entry point (Mdif = - 0.86, SD = 2.27) [t (31) = -3.96, p = 0.001]. CONCLUSION Proximal femur lengthening with the PRECICE IM nail significantly reduced the NSA and might cause Varus deformity. The level of osteotomy by OLC did not influence the amount of NSA reduction. The trochanteric entry points have a greater tendency to reduce the NSA compared to the piriformis entry points.
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Affiliation(s)
- Roy Gigi
- Department of Pediatric Orthopedic Surgery, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Yoram Hemo
- Department of Pediatric Orthopedic Surgery, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Baruch Danino
- Department of Pediatric Orthopedic Surgery, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Dror Ovadia
- Department of Pediatric Orthopedic Surgery, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Eitan Segev
- Department of Pediatric Orthopedic Surgery, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel.
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Tsang STJ, Ferreira N, Simpson AHRW. The reconstruction of critical bone loss : the holy grail of orthopaedics. Bone Joint Res 2022; 11:409-412. [PMID: 35731230 PMCID: PMC9233404 DOI: 10.1302/2046-3758.116.bjr-2022-0186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Shao-Ting J Tsang
- Department of Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK.,Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Nando Ferreira
- Division Orthopaedic Surgery Department of Surgical Sciences, Faculty of Medicine and Health Sciences Stellenbosch University, Cape Town, South Africa
| | - A H R W Simpson
- Department of Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK
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Elsheikh AA, Wright J, Stoddart MT, Goodier D, Calder P. Use of the Pixel Value Ratio Following Intramedullary Limb Lengthening: Uncomplicated Full Weight-bearing at Lower Threshold Values. Strategies Trauma Limb Reconstr 2022; 17:14-18. [PMID: 35734036 PMCID: PMC9166262 DOI: 10.5005/jp-journals-10080-1542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aims The pixel value ratio (PVR) can be used to assess regenerate consolidation after lengthening and guide advice for full weight-bearing (FWB). This study aimed to analyse the PVR in adults having femoral lengthening, the time to FWB and compare findings with the reported values in the literature. Materials and methods A retrospective database review identified 100 eligible patients who underwent lengthening using the PRECICE nail (68 antegrade and 32 retrograde). The PVR was calculated in each cortex on plain radiographs at every visit. The ratio between the regenerate and an average from the adjacent normal bone was calculated and plotted against the clinical decision to allow FWB. Results Eighty-seven patients (58 men and 29 women) were assessed; eleven had bilateral lengthening and two patients underwent lengthening twice. The median age was 30.5 years. The underlying cause of shortening was post-traumatic in 46%, with the remaining due to a wide variety of causes, including congenital 16%, syndromic 12% and other causes. The median lengthening achieved was 45 mm, at a median of 57.5 days. The PVR increased with each visit (p <0.0001). FWB was allowed at a median of 42 days after the last day of lengthening, with PVR values of 0.83, 0.84, 0.93 and 0.84 for the anterior, posterior, medial and lateral cortex noted, respectively (average 0.85). There were no implant failures, shortening or regenerate fractures. No differences were detected between antegrade and retrograde nails or with lengthening greater or less than 45 mm. One surgeon allowed earlier FWB at median 31 days with no nail failures. Conclusion PVR is a valuable tool that quantifies regenerate maturity and provides objectivity in deciding when to allow FWB after intramedullary lengthening with the PRECICE nail. FWB was permitted at an earlier time point, corresponding with lower PVR values than have been reported in the literature and with no mechanical failure or regenerate deformation. How to cite this article Elsheikh AA, Wright J, Stoddart MT, et al. Use of the Pixel Value Ratio Following Intramedullary Limb Lengthening: Uncomplicated Full Weight-bearing at Lower Threshold Values. Strategies Trauma Limb Reconstr 2022;17(1):14–18.
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Affiliation(s)
- Ahmed A Elsheikh
- Department of Orthopaedic Surgery, Faculty of Medicine, Benha University, Benha, Egypt
- Ahmed A Elsheikh, Department of Orthopaedic Surgery, Faculty of Medicine, Benha University, Benha, Egypt, e-mail:
| | - Jonathan Wright
- Paediatric and Limb Reconstruction Unit, Royal National Orthopaedic Hospital, London, United Kingdom
| | - Michael T Stoddart
- Limb Reconstruction Unit, Royal National Orthopaedic Hospital, London, United Kingdom
| | - David Goodier
- Paediatric and Limb Reconstruction Unit, Royal National Orthopaedic Hospital, London, United Kingdom
| | - Peter Calder
- Paediatric and Limb Reconstruction Unit, Royal National Orthopaedic Hospital, London, United Kingdom
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11
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Pain levels during distraction osteogenesis with lengthening nails in 168 cases. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:1167-1172. [PMID: 35476026 PMCID: PMC10125921 DOI: 10.1007/s00590-022-03266-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To firstly examine the pain levels during distraction osteogenesis (DO) with lengthening nails (LN) in a large sample. METHODS A total of 168 cases underwent DO of the tibia or femur with five different models of LN. Under a standardized medical regime, daily pain levels were noted as nominal rating scale (NRS) score (0-10) during the distraction phase. NRS scores and several potential influence factors (LN model, bone, approach, side, age, gender) were evaluated. RESULTS The mean distraction length was 39.1 ± 14.4 mm. The average NRS score decreased from postoperative day 1 with 2.84 nonlinearly by 1.03 points (36.3%) over the course of 62 days to an average score of 1.81. The mean decrease during the first thirty days was 0.67(23.6%). Subgroup analysis did not reveal any influence factors. CONCLUSION Pain levels during the distraction phase are overall low, continuously decreasing, and well manageable with mostly non-opioid analgesics.
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12
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Hafez M, Nicolaou N, Offiah A, Offorha B, Giles S, Madan S, Fernandes JA. Quality of life of children during distraction osteogenesis: a comparison between intramedullary magnetic lengthening nails and external fixators. INTERNATIONAL ORTHOPAEDICS 2022; 46:1367-1373. [PMID: 35385976 PMCID: PMC9117380 DOI: 10.1007/s00264-022-05399-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/31/2022] [Indexed: 12/01/2022]
Abstract
Background Distraction osteogenesis is a very demanding process. For decades, external fixation was the only reliable option for gradual deformity correction. Recently, intramedullary magnetic nails have gained popularity. This research aimed to assess the quality of life in children during gradual deformity correction using intramedullary lengthening nails compared to external fixation. Method Prospective analysis included children who had gradual lower limb deformity correction between 2017 and 2019. Group A included children who had magnetic lengthening nails; patients in group B had external fixation devices. Child health utility 9D (CHU- 9D) and EuroQol 5D youth (EQ- 5D-Y) were used to measure the quality of life at fixed points during the distraction osteogenesis process. The results were used to calculate the utility at each milestone and the overall quality of life adjusted years (QALYs). Results Thirty-four children were recruited, group A had 16 patients, whilst group B had 18 patients. The average ages were 16.0 years and 14.7 years for groups A and B, respectively. Group A patients reported significantly better utility compared to group B. This was observed during all stages of treatment (P = 0.00016). QALYs were better for group A (0.44) compared to group B (0.34) (P < 0.0001). Conclusion The quality of life was generally better in group A compared to group B. In most patients, the health utility progressively improved throughout treatment. In the same way, QALYs were better with the lengthening nails compared to external fixators. The magnetic lengthening devices (PRECICE nails) which were used in this research were recently relabelled to restrict their applications in children; this study was conducted before these restrictions.
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Affiliation(s)
- Mohamed Hafez
- Paediatric Limb Reconstruction Unit, Sheffield Children's Hospital, Western Bank, Sheffield, S10 2TH, UK. .,Oncology and Metabolism Department, Medical School, Sheffield University, Sheffield, UK.
| | - Nicolas Nicolaou
- Paediatric Limb Reconstruction Unit, Sheffield Children's Hospital, Western Bank, Sheffield, S10 2TH, UK.,Sheffield University, Sheffield, UK
| | - Amaka Offiah
- Oncology and Metabolism Department, Medical School, Sheffield University, Sheffield, UK
| | - Bright Offorha
- School of Health and Related Research, Sheffield University, Sheffield, UK
| | - Stephen Giles
- Paediatric Limb Reconstruction Unit, Sheffield Children's Hospital, Western Bank, Sheffield, S10 2TH, UK.,Sheffield University, Sheffield, UK
| | - Sanjeev Madan
- Paediatric Limb Reconstruction Unit, Sheffield Children's Hospital, Western Bank, Sheffield, S10 2TH, UK.,Sheffield University, Sheffield, UK
| | - James A Fernandes
- Paediatric Limb Reconstruction Unit, Sheffield Children's Hospital, Western Bank, Sheffield, S10 2TH, UK.,Sheffield University, Sheffield, UK
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Frommer A, Roedl R, Gosheger G, Niemann M, Turkowski D, Toporowski G, Theil C, Laufer A, Vogt B. What Are the Potential Benefits and Risks of Using Magnetically Driven Antegrade Intramedullary Lengthening Nails for Femoral Lengthening to Treat Leg Length Discrepancy? Clin Orthop Relat Res 2022; 480:790-803. [PMID: 34780384 PMCID: PMC8923575 DOI: 10.1097/corr.0000000000002036] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 10/08/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Limb lengthening with magnetically driven intramedullary lengthening nails is a fast-developing field and represents an alternative to external fixators. Although previous studies have assessed the application of magnetically driven intramedullary lengthening nails, these studies have been heterogenous regarding the nailing approach, the bone treated, and the implant type; they also have analyzed relatively small patient groups at short follow-up durations. QUESTIONS/PURPOSES (1) Is femoral lengthening with magnetically driven antegrade intramedullary lengthening nails accurate and precise? (2) What are the most common complications of treatment? (3) What factors are associated with unplanned additional surgery? METHODS We retrospectively analyzed the longitudinally maintained database of our orthopaedic teaching hospital to identify all patients who underwent surgery for leg length discrepancy (LLD) between October 2014 and April 2019. In total, we surgically treated 323 patients for LLD of 2 cm or more. Of those 55% (177 of 323) were treated with distraction osteogenesis with magnetically driven intramedullary lengthening nails, 18% (59 of 323) with external fixation, and 27% (87 of 323) with epiphysiodesis around the knee. Based on that, 29% (93 of 323) of patients underwent unilateral femoral distraction osteogenesis with magnetically driven antegrade femoral lengthening nails and were eligible for analysis. No patient was excluded, and 3% (3 of 93) were lost before the minimum study follow-up of 2 years, leaving 97% (90 of 93) for analysis. Patients with a distal femoral deformity were treated via a retrograde femoral approach (10% [33 of 323]) or with external fixators (3% [10 of 323]) and were not included in this study. Distraction osteogenesis with magnetically driven intramedullary lengthening nails was not considered for patients with deep tissue infection, those with bone dimensions considered to be too small in relation to the available implants, and for patients younger than 8 years. This study included 90 patients (44 females, 43 left femora) treated for a median (interquartile range) preoperative LLD of 39 mm (32 to 52) at a median age of 15 years (14 to 17). The same limb lengthening system was applied in all patients. The median (IQR) follow-up was 35 months (24 to 78). Data were acquired through a chart review performed by someone not involved in the surgical care of the included patients. Data acquisition was supervised and curated by two of the involved surgeons. Accuracy was calculated as 100 - [(achieved distraction in mm - planned distraction in mm) / (planned distraction in mm) x 100] and precision as 100 - (relative standard deviation of accuracy). Treatment-associated complications were summarized descriptively and characterized as complications resulting in unplanned additional surgery or those not resulting in unplanned surgery. To analyze the risk of unplanned additional surgery by entity, we calculated odds ratios (ORs) comparing the incidence of unplanned additional surgery in the different entity cohorts with the idiopathic LLD cohort as a reference. By calculating ORs, we analyzed the risk for unplanned additional surgery depending on sex, age, surgery time, and previous lengthening. Due to the lack of long-term evidence about motorized lengthening nails remaining in situ and concerns about potential implant-related adverse effects, removal was routinely scheduled 1 year after consolidation. For implant removal, 92% (83 of 90) of patients underwent planned additional surgery, which was not recorded as an adverse event of the treatment. Ninety-seven percent (87 of 90) of patients completed lengthening with the implant remaining in situ until the end of distraction. The median (IQR) distraction length was 37 mm (30 to 45) with a median distraction index of 0.9 mm/day (0.7 to 1.0) and median consolidation index of 31 days/cm (25 to 42). RESULTS The calculated accuracy and precision were 94% and 90%, respectively. In total, 76% (68 of 90) of our patients experienced complications, which resulted in 20% (18 of 90) of patients undergoing unplanned additional surgery. The most common complication overall was adjustment of the distraction rate in 27% (24 of 90) of patients (faster: 16% [14 of 90]; slower: 11% [10 of 90]) and temporary restriction of knee motion, which occurred in 20% (18 of 90) of our patients and resolved in all patients who experienced it. The most serious complications were bacterial osteomyelitis and knee subluxation, which occurred in 3% (3 of 90) and 1% (1 of 90) of our patients, respectively. With the numbers available, we found only one factor associated with an increased likelihood of unplanned additional surgery: Patients with postinfectious LLD had higher odds of unplanned additional surgery than patients with idiopathic LLD (7% [1 of 15] versus 50% [3 of 6], OR 14.0 [95% CI 1.06 to 185.49]; p = 0.02). However, we caution readers this finding is fragile, and the confidence interval suggests that the effect size estimate is likely to be imprecise. CONCLUSION Femoral distraction osteogenesis with magnetically driven antegrade intramedullary lengthening nails appears to be an accurate and reliable treatment for femoral lengthening. However, depending on the etiology, a high risk of unplanned additional surgery should be anticipated, and a high proportion of patients will experience temporary joint stiffness. We recommend close orthopaedic follow-up and physiotherapy during treatment. This treatment of LLD can be considered alongside other nails, external fixators, and epiphysiodesis. Multicenter studies comparing this with other approaches are needed. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Adrien Frommer
- Pediatric Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, Muenster, Germany
| | - Robert Roedl
- Pediatric Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, Muenster, Germany
| | - Georg Gosheger
- General Orthopaedics and Tumor Orthopaedics, University Hospital Muenster, Muenster, Germany
| | - Maike Niemann
- Pediatric Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, Muenster, Germany
| | - Dominik Turkowski
- Pediatric Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, Muenster, Germany
| | - Gregor Toporowski
- Pediatric Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, Muenster, Germany
| | - Christoph Theil
- Pediatric Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, Muenster, Germany
| | - Andrea Laufer
- Pediatric Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, Muenster, Germany
| | - Bjoern Vogt
- Pediatric Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, Muenster, Germany
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14
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Hafez M, Nicolaou N, Offiah AC, Giles S, Madan S, Fernandes JA. Femoral lengthening in young patients: An evidence-based comparison between motorized lengthening nails and external fixation. World J Orthop 2021; 12:909-919. [PMID: 34888151 PMCID: PMC8613692 DOI: 10.5312/wjo.v12.i11.909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/07/2021] [Accepted: 10/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Femoral lengthening is a procedure of great importance in the treatment of congenital and acquired limb deficiencies. Technological advances have led to the latest designs of fully implantable motorized intramedullary lengthening nails. The use of these nails has increased over the last few years.
AIM To review and critically appraise the literature comparing the outcome of femoral lengthening in children using intramedullary motorized lengthening nails to external fixation.
METHODS Electronic databases (MEDLINE, CINAHL, EMBASE, Cochrane) were systematically searched in November 2019 for studies comparing the outcome of femoral lengthening in children using magnetic lengthening nails and external fixation. The outcomes included amount of gained length, healing index, complications and patient reported outcomes.
RESULTS Of the 452 identified studies, only two (retrospective and non-randomized) met the inclusion criteria. A total of 91 femora were included. In both studies, the age of patients treated with nails ranged from 15 to 21 years compared to 9 to 15 years for patients in the external fixation group. Both devices achieved the target length. Prevalence of adverse events was less in the nail (60%-73%) than in the external fixation (81%-100%) group. None of the studies presented patient reported outcomes.
CONCLUSION The clinical effectiveness of motorized nails is equivalent or superior to external fixation for femoral lengthening in young patients. The available literature is limited and does not provide evidence on patient quality of life or cost effectiveness of the interventions.
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Affiliation(s)
- Mohamed Hafez
- Department of Oncology and Metabolism, Sheffield University, Sheffield S10 2TN, United Kingdom
- Department of Paedaiatric Limb Reconstruction, Sheffield Children Hospital, Sheffield S10 2TH, United Kingdom
| | - Nicolas Nicolaou
- Department of Paedaiatric Limb Reconstruction, Sheffield Children Hospital, Sheffield S10 2TH, United Kingdom
| | - Amaka C Offiah
- Department of Radiology, Sheffield Children Hospital, Sheffield S10 2TH, United Kingdom
| | - Stephen Giles
- Department of Paedaiatric Limb Reconstruction, Sheffield Children Hospital, Sheffield S10 2TH, United Kingdom
| | - Sanjeev Madan
- Department of Paedaiatric Limb Reconstruction, Sheffield Children Hospital, Sheffield S10 2TH, United Kingdom
| | - James A Fernandes
- Department of Paedaiatric Limb Reconstruction, Sheffield Children Hospital, Sheffield S10 2TH, United Kingdom
- Department of Trauma and Orthopaedics, Sheffield Children Hospital, Sheffield S10 2Th, United Kingdom
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15
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Acute Femoral Lengthening in Adults Using Step-Cut Osteotomy, Traction Table, and Proximal Femoral Locking Plate Fixation: Surgical Technique and Report of Three Cases. Indian J Orthop 2021; 56:559-565. [PMID: 35342530 PMCID: PMC8921383 DOI: 10.1007/s43465-021-00547-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/10/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Leg-length discrepancy (LLD) can cause distinct gait and posture disorders that may lead to lifestyle-limiting disability and premature joint degeneration. The purpose of this study was to describe a novel surgical method for acute femoral lengthening in adults with symptomatic structural LLD using step-cut osteotomy, traction table, and proximal femoral locking plate fixation. MATERIALS AND METHODS We retrospectively evaluated three consecutive adult patients that underwent the procedure at our institution between 2011 and 2019, describing the surgical technique and presenting a report of three cases, including complications assessment. RESULTS The average age was 47 years (range 38-58), average BMI was 28.1 kg/m2 (range 26.8-29.9), average ASA score was 2 (range 1-3). The mean pre-operative shortening (2 congenital, 1 posttraumatic) was 21 mm (range 20-23). The average elongation achieved was 18 mm (range 15-20). The average surgery duration was 142 min (range 120-165) and the average estimated blood loss was 558 mL (range 375-900). Symptoms were relieved after the lengthening in all three cases. We observed no complications after the mean 68 months (range 22-125) of follow-up. CONCLUSIONS Successful correction of structural LLD is challenging, depends on patient selection, meticulous planning, surgical technique and experience. Therefore, it should be considered case-by-case. In the hands of an experienced surgeon, our method of acute femoral lengthening seems safe and suitable for carefully selected cases of structural LLD correction, where the final lengthening goal remains within the critical limits of one-stage leg lengthening and principles of traction table use.
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16
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Popkov A, Pietrzak S, Antonov A, Parol T, Lazović M, Podeszwa D, Popkov D. Combined lengthening for acquired leg length discrepancy: Are there advantages of hydroxyapatite-coated intramedullary nails? Orthop Traumatol Surg Res 2021; 109:103101. [PMID: 34628087 DOI: 10.1016/j.otsr.2021.103101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/06/2021] [Accepted: 02/10/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The aim of this multicenter prospective study was to analyze the outcomes of bone lengthening by external fixator associated with flexible intramedullary nailing (FIN) in acquired limb length discrepancy (LLD). HYPOTHESIS Hydroxyapatite (HA)-coated FIN enables reduced External Fixation Index in limb lengthening for acquired leg length discrepancies in comparison to non-HA-coated FIN. MATERIAL AND METHODS This study included 54 patients (mean age, 17.9 years) operated on for femoral or tibial lengthening by combined technique (External fixator with FIN) for acquired length discrepancy. Titanium non-HA-coated FIN (29 cases) or HA-coated FIN (25 cases) were used. The factors that might influence external fixation index, complication occurrence and outcome were analyzed: age, amount of lengthening, nail diameter, HA-coating vs. non-HA-coated nails. RESULTS The mean External Fixation Indexes (EFI) of groups compared for non-HA-coated nails vs. HA-coated nails were not significantly different: 26.5 d/cm and 27.2 d/cm in femoral lengthening and 34.9 d/cm and 31.7 d/cm in tibial lengthening. Positive correlation between the "nail diameter/inner distance between cortices at osteotomy site" ratio and EFI in tibial lengthening was revealed (p=0.034). The nail types and the "nail diameter/medullary canal diameter" ratio interact and have significant simultaneous effect on EFI in femoral lengthening (p=0.021). DISCUSSION The results of this study revealed no differences with regards to EFI using HA-coated or non-HA-coated titanium FIN in lengthening for acquired leg-length discrepancies. Combined technique allowed reduced EFI and avoided major complications. Both non-HA-nail and HA-coated nail lengthening provided good and excellent outcomes. LEVEL OF EVIDENCE III; (controlled trial without randomization) prospective comparative study.
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Affiliation(s)
- Arnold Popkov
- Ilizarov National Medical Center for Traumatology and Orthopaedics, Kurgan, Russian Federation
| | - Szymon Pietrzak
- Department of Orthopaedics, Children's Orthopaedics and Traumatology Medical Center of Postgraduate Education, Otwock, Poland
| | - Alexander Antonov
- Ilizarov National Medical Center for Traumatology and Orthopaedics, Kurgan, Russian Federation
| | - Tomasz Parol
- Department of Orthopaedics, Children's Orthopaedics and Traumatology Medical Center of Postgraduate Education, Otwock, Poland
| | - Mikan Lazović
- Orthopaedic Department, Children's University Hospital, Tiršova 10, Belgrade, Serbia
| | - David Podeszwa
- Department of Orthopaedics, Texas Scottish Rite Hospital for Children, Dallas, Texas, USA
| | - Dmitry Popkov
- Ilizarov National Medical Center for Traumatology and Orthopaedics, Kurgan, Russian Federation.
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17
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Masci G, Palmacci O, Vitiello R, Bonfiglio N, Bocchi MB, Cipolloni V, Maccauro G, Pola E. Limb lengthening with PRECICE magnetic nail in pediatric patients: A systematic review. World J Orthop 2021; 12:575-583. [PMID: 34485104 PMCID: PMC8384613 DOI: 10.5312/wjo.v12.i8.575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/12/2021] [Accepted: 06/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Limb lengthening techniques play an increasingly important role in the pediatric orthopedic field. The principles of the osteogenesis distraction bonded traditionally with external fixators; however, the recent deployment of fully implantable systems has been able to overcome severities related to external fixators. The PRECICE® is an implantable limb lengthening intramedullary nail system that is remotely controlled and magnetically driven.
AIM To review the current literature available on this matter in order to assess the PRECICE clinical and radiological outcomes and its possible complications in a population of pediatric patients undergoing limb lengthening.
METHODS Only five studies met the inclusion criteria and were consequently included in the review for a total of 131 patients and 135 femurs. The clinical and radiological outcomes of interest were: the main lengthening obtained, the distraction rate, the period of time to full weight bearing, the consolidation index, and the Association for the Study and Application of Methods of Ilizarov score.
RESULTS In conclusion, data collected from the articles under investigation were comparable with the exception of the consolidation index. Unfortunately, the study population was too small and the patients’ follow-up was too short to make definitive conclusions.
CONCLUSION This review shows that the PRECICE Nail System is still a therapeutic challenge in limb lengthening for pediatric orthopedic surgeons; however, careful pre-operative planning and an accurate surgical technique could allow the correction of more complex deformities with a low rate of complications.
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Affiliation(s)
- Giulia Masci
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Osvaldo Palmacci
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Raffaele Vitiello
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Nadia Bonfiglio
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Maria Beatrice Bocchi
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Valerio Cipolloni
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Giulio Maccauro
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Enrico Pola
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
- Policlinico di Napoli University Hospital, Università della Campania Luigi Vanvitelli School of Medicine, Napoli 80100, Italy
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Hothi H, Bergiers S, Henckel J, Iliadis AD, Goodier WD, Wright J, Skinner J, Calder P, Hart AJ. Analysis of retrieved STRYDE nails. Bone Jt Open 2021; 2:599-610. [PMID: 34352183 PMCID: PMC8384447 DOI: 10.1302/2633-1462.28.bjo-2021-0126] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Aims The aim of this study was to present the first retrieval analysis findings of PRECICE STRYDE intermedullary nails removed from patients, providing useful information in the post-market surveillance of these recently introduced devices. Methods We collected ten nails removed from six patients, together with patient clinical data and plain radiograph imaging. We performed macro- and microscopic analysis of all surfaces and graded the presence of corrosion using validated semiquantitative scoring methods. We determined the elemental composition of surface debris using energy dispersive x-ray spectroscopy (EDS) and used metrology analysis to characterize the surface adjacent to the extendable junctions. Results All nails were removed at the end of treatment, having achieved their intended lengthening (20 mm to 65 mm) and after regenerate consolidation. All nails had evidence of corrosion localized to the screw holes and the extendable junctions; corrosion was graded as moderate at the junction of one nail and severe at the junctions of five nails. EDS analysis showed surface deposits to be chromium rich. Plain radiographs showed cortical thickening and osteolysis around the junction of six nails, corresponding to the same nails with moderate – severe junction corrosion. Conclusion We found, in fully united bones, evidence of cortical thickening and osteolysis that appeared to be associated with corrosion at the extendable junction; when corrosion was present, cortical thickening was adjacent to this junction. Further work, with greater numbers of retrievals, is required to fully understand this association between corrosion and bony changes, and the influencing surgeon, implant, and patient factors involved. Cite this article: Bone Jt Open 2021;2(8):599–610.
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Affiliation(s)
- Harry Hothi
- The Royal National Orthopaedic Hospital, London, UK
| | | | | | | | | | - Jonathan Wright
- The Royal National Orthopaedic Hospital, London, UK.,The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - John Skinner
- The Royal National Orthopaedic Hospital, London, UK
| | - Peter Calder
- The Royal National Orthopaedic Hospital, London, UK
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Efficacy of PRECICE Nail in Treatment of Adult Patients With Posttraumatic Femoral Leg Length Discrepancy. J Orthop Trauma 2021; 35:e304-e308. [PMID: 33512857 DOI: 10.1097/bot.0000000000002000] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2020] [Indexed: 02/02/2023]
Abstract
Posttraumatic, limb length discrepancy in adults is a challenge to treat, and multiple treatment protocols over the years have shown varying levels of success and complications. Before the introduction of the PRECICE nail in 2011, our preferred method of limb lengthening used an Ilizarov or Taylor Spatial frame. To assess the PRECICE nail, we evaluated the accuracy and complications during treatment in a series of skeletally mature patients with posttraumatic femoral limb length discrepancy. The surgical technique along with a case series of 8 patients are described in detail. On average, the target lengthening for the PRECICE nail was 44 mm, and all patients achieved lengthening within 2 mm and complete bony consolidation. The only observed complication in our series was a broken screw 1 year after the patient started weight-bearing. The PRECICE nail demonstrated promising results and was useful for bone regeneration and consolidation without the need for additional procedures. The rate of complications was low compared with previous methods, making this device an excellent treatment option.
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20
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Popkov A, Pietrzak S, Antonov A, Parol T, Lazović M, Podeszwa D, Popkov D. Limb Lengthening for Congenital Deficiencies Using External Fixation Combined With Flexible Intramedullary Nailing: A Multicenter Study. J Pediatr Orthop 2021; 41:e439-e447. [PMID: 33782369 DOI: 10.1097/bpo.0000000000001816] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hydroxyapatite (HA) coated flexible intramedullary nailing (FIN) stimulates osteogenic activity. The role of HA-coated intramedullary nails remains unclear in normal bone lengthening. The goal of this study was to quantify the influence of FIN on the External Fixation Index (EFI) in patients with congenital lower limb discrepancy. METHODS Patients with femoral deficiency and fibular hemimelia underwent lengthening by the combined technique of external fixation with titanium (Ti) FIN or HA coated FIN and returned for follow-up at least 12 months after frame removal. RESULTS Seventy patients (mean age of 12.6 y) were included: 19 monofocal femoral lengthenings, 35 tibial monofocal lengthenings, 16 tibial bifocal lengthenings. The mean EFI's for those treated with and without HA-coated nails were not significantly different. The Conover posthoc analysis did not reveal a significant influence of the type of FIN on EFI in any subgroup. However, 2-way analysis of variance revealed simultaneous effects of nail types and age on the EFI in tibial bifocal lengthening.Significant positive correlation between the ratio "nail diameter/medullary shaft diameter" and EFI in tibial bifocal non-HA-coated FIN lengthening, and a significant positive correlation between age and EFI for femoral non-HA-coated FIN lengthening, tibial monofocal and bifocal HA-coated FIN lengthening were revealed.There were 4 cases of fracture at lengthening site required unscheduled surgery. In the non-HA-coated group, there was a statistically significant negative correlation between nail diameter and fracture occurrence at the lengthening site after frame removal. A ratio of <0.15 likely does not ensure required mechanical stability and support. CONCLUSIONS Both Ti-nail and HA-coated nail lengthening provide good and excellent outcomes for femoral and tibial monosegmental lengthening procedures and ensure reduced EFI. In congenital disorders which were not associated with abnormal bone, there are no differences with regard to EFI using HA-coated or non-HA-coated FIN. The ratio of "elastic Ti-nail diameter/medullary canal diameter at narrowest site" <0.15 seems to be associated with higher risk of fracture at the lengthening site after frame removal.
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Affiliation(s)
- Arnold Popkov
- Ilizarov National Medical Center for Traumatology and Orthopaedics, Kurgan, Russian Federation
| | - Szymon Pietrzak
- Department of Orthopaedics, Children's Orthopaedics and Traumatology Medical Center of Postgraduate Education, Otwock, Poland
| | - Alexander Antonov
- Ilizarov National Medical Center for Traumatology and Orthopaedics, Kurgan, Russian Federation
| | - Tomasz Parol
- Department of Orthopaedics, Children's Orthopaedics and Traumatology Medical Center of Postgraduate Education, Otwock, Poland
| | - Mikan Lazović
- Orthopaedic Department, Children's University Hospital, Belgrade, Serbia
| | - David Podeszwa
- Department of Orthopaedics, Scottish Rite Hospital for Children, Dallas, TX
| | - Dmitry Popkov
- Ilizarov National Medical Center for Traumatology and Orthopaedics, Kurgan, Russian Federation
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21
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Iliadis AD, Wright J, Stoddart MT, Goodier WD, Calder P. Early results from a single centre's experience with the STRYDE nail : a cause for concern? Bone Joint J 2021; 103-B:1168-1172. [PMID: 34058877 DOI: 10.1302/0301-620x.103b6.bjj-2020-2165.r1] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The STRYDE nail is an evolution of the PRECICE Intramedullary Limb Lengthening System, with unique features regarding its composition. It is designed for load bearing throughout treatment in order to improve patient experience and outcomes and allow for simultaneous bilateral lower limb lengthening. The literature published to date is limited regarding outcomes and potential problems. We report on our early experience and raise awareness for the potential of adverse effects from this device. METHODS This is a retrospective review of prospective data collected on all patients treated in our institution using this implant. We report the demographics, nail accuracy, reliability, consolidation index, and cases where concerning clinical and radiological findings were encountered. There were 14 STRYDE nails implanted in nine patients (three male and six female) between June 2019 and September 2020. Mean age at surgery was 33 years (14 to 65). Five patients underwent bilateral lengthening (two femoral and three tibial) and four patients unilateral femoral lengthening for multiple aetiologies. RESULTS At the time of reporting, eight patients (13 implants) had completed lengthening. Osteolysis and periosteal reaction at the junction of the telescopic nail was evident in nine implants. Five patients experienced localized pain and swelling. Macroscopic appearances following retrieval were consistent with corrosion at the telescopic junction. Tissue histology was consistent with effects of focal metallic wear debris. CONCLUSION From our early experience with this implant we have found the process of lengthening to be accurate and reliable with good regenerate formation and consolidation. Proposed advantages of early load bearing and the ability for bilateral lengthening are promising. We have, however, encountered concerning clinical and radiological findings in several patients. We have elected to discontinue its use to allow further investigation into the retrieved implants and patient outcomes from users internationally. Cite this article: Bone Joint J 2021;103-B(6):1168-1172.
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Affiliation(s)
| | - Jonathan Wright
- Limb Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | | | | | - Peter Calder
- Limb Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, UK
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Zhang J, Zhang Y, Wang C, Qin S. [Research progress of intramedullary lengthening nail technology]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:642-647. [PMID: 33998220 DOI: 10.7507/1002-1892.202012084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To review the research progress of intramedullary lengthening nail technology. Methods The foreign literature on the development history, types, advantages and disadvantages, indications and contraindications, complications, and effectiveness of intramedullary lengthening nail were reviewed and analyzed. Results The intramedullary lengthening nail system mainly includes mechanical type, electric motor drive type, and magnetic drive type. Compared with traditional external fixation and lengthening technology, the intramedullary lengthening nail technology has certain advantages in incidence of complications, bone healing, postoperative functional rehabilitation, incision aesthetics, convenience, and patient satisfaction. However, there are also shortcomings, such as pain, uncontrollable distraction rate, device failure, etc. In the clinical application of intramedullary lengthening nails for limb lengthening, the indications should be grasped reasonably, and the related complications should be prevented and treated. Conclusion Intramedullary lengthening nails provide a new option for limb lengthening, and the initial effectiveness is good. It is one of the development direction of limb lengthening technology.
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Affiliation(s)
- Jin Zhang
- Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan Shanxi, 030001, P.R.China
| | - Yonghong Zhang
- Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan Shanxi, 030001, P.R.China
| | - Chaoqi Wang
- Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan Shanxi, 030001, P.R.China
| | - Sihe Qin
- Department of Orthopaedics, Rehabilitation Hospital of the National Research Center for Rehabilitation Technical Aids, Beijing, 100176, P.R.China
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Sun W, Li M, Zhang Y, Huang Y, Zhan Q, Ren Y, Dong H, Chen J, Li Z, Fan C, Huang F, Shen Z, Jiang Z. Total flavonoids of rhizoma drynariae ameliorates bone formation and mineralization in BMP-Smad signaling pathway induced large tibial defect rats. Biomed Pharmacother 2021; 138:111480. [PMID: 33774316 DOI: 10.1016/j.biopha.2021.111480] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/04/2021] [Accepted: 03/06/2021] [Indexed: 11/29/2022] Open
Abstract
Osteogenesis and angiogenesis acts as an essential role in repairing large tibial defects (LTDs). Total flavonoids of rhizoma drynariae (TFRD), a traditional Chinese medicinal herb, is reported to show anabolic effects on fracture healing. However, whether TFRD could improve the bone formation and angiogenesis in LTDs remains unknown. The purpose of this study was to evaluate the effect of TFRD on bone formation and angiogenesis in LTDs in distraction osteogenesis (DO). Using a previously established fracture model, LTD rats was established with circular external fixator (CEF). All rats then randomly divided into TFRD low dosage group (with DO), TFRD medium dosage group (with DO), TFRD high dosage group (with DO), model group (with DO) and blank group (without DO). Twelve weeks after treatment, according to X-ray and Micro-CT, TFRD groups (especially in medium dosage group) can significantly promote the formation of a large number of epiphyses and improve new bone mineralization compared with model group, and the results of HE and Masson staining and in vitro ALP level of BMSC also demonstrated the formation of bone matrix and mineralization in the TFRD groups. Also, angiographic imaging suggested that total flavonoids of TFRD was able to promote angiogenesis in the defect area. Consistently, TFRD significantly increased the levels of BMP-2, SMAD1, SMAD4, RUNX-2, OSX and VEGF in LTD rats based on ELISA and Real-Time PCR. In addition, we found that ALP activity of TFRD medium dosage group reached a peak after 10 days of induction through BMSC cell culture in vitro experiment. TFRD promoted bone formation in LTD through activation of BMP-Smad signaling pathway, which provides a promising new strategy for repairing bone defects in DO surgeries.
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Affiliation(s)
- Weipeng Sun
- First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Minying Li
- Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Yan Zhang
- First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Yingjie Huang
- First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Qunzhang Zhan
- First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Yueyi Ren
- First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Hang Dong
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Jiena Chen
- Institute of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Zige Li
- First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Chun Fan
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Feng Huang
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Zhen Shen
- Department of Orthopaedics, Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming Municipal, Yunnan Province, China.
| | - Ziwei Jiang
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China.
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Johnson MA, Karkenny AJ, Arkader A, Davidson RS. Dissociation of a Femoral Intramedullary Magnetic Lengthening Nail During Routine Hardware Removal: A Case Report. JBJS Case Connect 2021; 11:01709767-202103000-00046. [PMID: 33684083 DOI: 10.2106/jbjs.cc.20.00950] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
CASE A 15-year-old boy with a right femur length discrepancy secondary to infection underwent hardware removal 1-year status-post right femur osteotomy with placement of an antegrade intramedullary magnetic lengthening nail after successful lengthening of 4.2 cm. During hardware removal, dissociation between the proximal (outer) and distal (inner) components of the device was observed. The distal component was removed using an endoscopic pituitary rongeur after considering multiple possible techniques. CONCLUSIONS In the event of nail disconnection during removal of an intramedullary implant, we recommend use of a long pituitary rongeur to retrieve the distal nail component.
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Affiliation(s)
- Mitchell A Johnson
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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25
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Abood AA, Rahbek O, Olesen ML, Christensen BB, Møller-Madsen B, Kold S. Does Retrograde Femoral Nailing through a Normal Physis Impair Growth? An Experimental Porcine Model. Strategies Trauma Limb Reconstr 2021; 16:8-13. [PMID: 34326896 PMCID: PMC8311745 DOI: 10.5005/jp-journals-10080-1515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Materials and methods The study was carried out using an experimental porcine model. Eleven juvenile female porcines were randomized for insertion of a retrograde femoral nail in one limb. The other limb acted as a control. The animals were housed for 8 weeks before the nail was removed and housed for 8 additional weeks, that is, 16 weeks in total. Growth was assessed by interphyseal distance on 3D magnetic resonance imaging (MRI) after 16 weeks and the operated limb was compared to the non-operated limb. Histomorphometric analysis of the physeal canal was performed. Results No difference in longitudinal growth was observed when comparing the operated femur to the non-operated femur using MRI after 16 weeks. No osseous tissue crossing the physis was observed on MRI or histology. The empty canal in the physis after nail removal was filled with fibrous tissue 16 weeks after primary surgery. Conclusion Growth was not impaired and no bone bridges were seen on MRI or histology 16 weeks after insertion and later removal of the retrograde femoral nail. Clinical significance The insertion of a retrograde intramedullary femoral nail centrally through the physis and later removal might be safe, however, long-term follow-up is needed. Aim and objective The insertion of an intramedullary nail may be beneficial in certain cases of leg length discrepancy (LLD) in children. However, it is unknown if the physeal injury due to the surgery may cause bone bridge formation and thereby growth arrest after removal. This study aimed to assess longitudinal interphyseal growth 16 weeks after insertion and later removal of a retrograde femoral nail passing through the physis. Moreover, to analyse the tissue forming in the empty physeal canal after removal of the nail. How to cite this article Abood AA, Rahbek O, Olesen ML, et al. Does Retrograde Femoral Nailing through a Normal Physis Impair Growth? An Experimental Porcine Model. Strategies Trauma Limb Reconstr 2021;16(1):8–13.
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Affiliation(s)
- Ahmed A Abood
- Department of Orthopaedics and Reconstruction, Aalborg University Hospital, Aalborg, Denmark
| | - Ole Rahbek
- Department of Orthopaedics and Reconstruction, Aalborg University Hospital, Aalborg, Denmark
| | - Morten L Olesen
- Department of Orthopaedics and Reconstruction, Aarhus University Hospital, Aarhus, Denmark
| | - Bjørn B Christensen
- Department of Orthopaedics and Reconstruction, Aarhus University Hospital, Aarhus, Denmark
| | - Bjarne Møller-Madsen
- Department of Orthopaedics and Reconstruction, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Kold
- Department of Orthopaedics and Reconstruction, Aalborg University Hospital, Aalborg, Denmark
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Abstract
BACKGROUND Limb lengthening using intramedullary externally controlled motorized devices is becoming increasingly popular. There is limited literature regarding their use in the pediatric and adolescent population. This study reviews outcomes on 50 consecutive cases of intramedullary lower limb lengthening surgery in this population. METHODS A retrospective review of all pediatric and adolescent patients treated in our institution by intramedullary lengthening for lower limb length discrepancy using the PRECICE and STRYDE intramedullary lengthening nails between 2013 and 2019. All patients were operated by a single surgeon. Data were prospectively recorded. We report on nail accuracy and reliability, consolidation index, time to full weight-bearing from completion of lengthening, joint range of movement, ASAMI bone and functional scores, presence of problems, obstacles and complications, and patient reported outcome measures (PROMS). RESULTS Fifty cases (43 femoral and 7 tibial nails) were performed in 42 patients (20 males, 48% and 22 females, 52%). Six patients had bilateral lengthening and 2 patients had sequential lengthening. There were 28 antegrade femoral, 13 retrograde femoral and 5 tibia PRECICE nails, 2 tibial and 2 femoral PRECICE STRYDE nails. Mean age at surgery was 15 years old (12 to 17). Mean preoperative length discrepancy was 49 mm (20 to 90). Mean achieved lengthening was 46.5 mm (20 to 80). Mean percentage lengthening was 12.6% (5% to 25%). Nail accuracy was 96% and reliability 90%. Average distraction rate was 0.92 mm/d for femur and 0.64 mm/d for tibias. Consolidation index was 28 d/cm (18 to 43) and 39 d/cm (20 to 47), respectively. Time from completion of lengthening to independent full weight-bearing as observed in clinic was 45 days (21 to 70) and 34.2 days (23 to 50), respectively. ASAMI bone and functional scores were favorable and PROMS demonstrated high patient satisfaction levels. No significant complications were observed. CONCLUSIONS We have demonstrated excellent clinical results and high patient satisfaction with intramedullary lengthening in a pediatric/adolescent population. We highly recommend thorough preoperative preparation, patient education, and a multidisciplinary approach. LEVEL OF EVIDENCE Level IV.
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Summers S, Krkovic M. Bone transport with magnetic intramedullary nails in long bone defects. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:1243-1252. [PMID: 33367945 PMCID: PMC7759217 DOI: 10.1007/s00590-020-02854-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/14/2020] [Indexed: 12/22/2022]
Abstract
Background This study describes the outcomes of internal bone transport with magnetic nails in five cases of traumatic segmental femoral bone defects. Methods Five patients with open fracture of the femur and diaphyseal bone loss were included between May 2018 and August 2020. The mean femoral defect was 8.7 cm (range 5.6–16.0). Intervention We used plate-assisted bone segment transport (PABST) with PRECICE magnetic nails. Results All five patients have fully consolidated. The mean consolidation time and index were 7.5 months and 0.8 mo/cm, respectively. The mean follow-up was 21.3 months. The main complications were reduced knee ROM, mild varus deformity and plate bending. Post-operative SF-36, Oxford Knee scores and ED-5Q-5L scores were also compiled for four of five patients. SF-36 and Oxford Knee scores were reported without pre-injury data for comparison. ED-5Q-5L index and VAS were compared UK population norm and were both found to be statistically insignificant (p = 0.071 and p = 0.068, respectively). Conclusion Bone transport with magnetic nails has the capacity to obtain good functional recovery in long bone defects despite variable outcome pictures. In response to variable outcome reporting in the literature, we propose a standard reporting template for future studies to facilitate more rigorous analyses.
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Affiliation(s)
- Selina Summers
- School of Clinical Medicine, Addenbrooke’s Hospital, University of Cambridge, Cambridge, CB2 0SP UK
| | - Matija Krkovic
- Addenbrookes Major Trauma Unit, Department of Trauma and Orthopaedics, Cambridge University Hospitals, Cambridge, UK
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HURİ G. Adjustable bone plate: state of art. Turk J Med Sci 2020; 50:1723-1727. [PMID: 32222126 PMCID: PMC7672350 DOI: 10.3906/sag-2002-69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 03/22/2020] [Indexed: 11/03/2022] Open
Abstract
Background/aim The success of treatment of bone fracture and defects are based on a proper contact and compression between the bone fracture fragments. Intraoperative manipulations such as bone compression or distractions are generally done in order to achieve this. However, none of the bone plates currently in routine use allow these manipulations after fixation to the bone, requiring refixation and repeated drilling, and screwing operations. Based on this shortcoming, we designed a novel adjustable bone plate (ABP) system which allows bone shortening and lengthening even after fixation to the bone surface. The aim of the paper is to clarify the unique properties of the novel bone plate. Materials and methods In this paper, the new generation adjustable bone plate applicability, design, indication, and new characteristics in addition to conventional bone plates with review of the literature were discussed and surgical technique was demonstrated in a saw bone model. Results This novel design allows for compression and distraction at the fracture ends post fixation as well as bone segment transfers. Conclusions The potential of the new generation ABP plate for use in bone compression, distraction, and the segmental bone transfer is a promising invention for clinical applications in the future.
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Affiliation(s)
- Gazi HURİ
- Department of Orthopaedics and Traumatology, Hacettepe University, AnkaraTurkey
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29
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Lecoanet P, Legallois Y, Ribes C, Lefevre Y, Cadennes A, Fabre T. Medium-term evaluation of leg lengthening by ISKD® intramedullary nail in 28 patients: Should we still use this lengthening system? Orthop Traumatol Surg Res 2020; 106:1433-1440. [PMID: 33087298 DOI: 10.1016/j.otsr.2020.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 03/25/2020] [Accepted: 06/02/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Lower-limb lengthening presently uses intramedullary nailing. There are motorized systems and mechanical systems, each with their specific complications. The aim of the present study was to assess the efficacy of ISKD® mechanical nails (Orthofix Inc., Texas, USA) on 3D EOS® imaging, and also complications and functional impact. HYPOTHESIS The study hypothesis was that nail lengthening is effective but should no longer use the ISKD® system, due to the high rate of specific complications. MATERIAL AND METHODS A single-center retrospective study included 28 patients (14 female, 14 male) undergoing limb-lengthening by ISKD® nail between 2005 and 2018. Mean age was 29 years. Twenty-four procedures were femoral and 4 tibial. Lengthening and consolidation parameters and residual discrepancy were measured on 3D EOS® imaging. Complications and functional scores were collated. RESULTS Twenty-eight ISKD® nails were implanted in 28 patients. Mean follow-up was 75 months. Planned lengthening was achieved in 78.5% of cases, for a mean lengthening of 34.5mm. Mean lengthening and consolidation indices were respectively 0.94mm/day and 105 days/cm. Length discrepancy showed significant correction, with improvement in functional scores (p<0.01). The overall complications rate was 67.9%, 76% of which were specific to the ISKD® nail. DISCUSSION The present study confirmed that nail lengthening is an indication of choice in lower-limb length discrepancy, but that the ISKD® system should no longer be used, due to an excessive rate of specific complications. Complications are due to deficient control of lengthening rate, not found with new-generation motorized nails, which show much fewer complications. LEVEL OF EVIDENCE IV, retrospective study without control group.
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Affiliation(s)
- Paul Lecoanet
- CHU Bordeaux, place Amélie Raba-Léon, 33000 Bordeaux, France.
| | - Yohan Legallois
- CHU Bordeaux, place Amélie Raba-Léon, 33000 Bordeaux, France
| | - Clément Ribes
- Hôpital d'Instruction des Armées Robert Picqué, 351, route de Toulouse, 33140 Villenave-d'Ornon, France
| | - Yan Lefevre
- CHU Bordeaux, place Amélie Raba-Léon, 33000 Bordeaux, France
| | - Adrien Cadennes
- CHU Bordeaux, place Amélie Raba-Léon, 33000 Bordeaux, France
| | - Thierry Fabre
- CHU Bordeaux, place Amélie Raba-Léon, 33000 Bordeaux, France
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31
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Theyse LFH. CORR Insights®: Percutaneous CO2 Treatment Accelerates Bone Generation During Distraction Osteogenesis in Rabbits. Clin Orthop Relat Res 2020; 478:1936-1938. [PMID: 32732578 PMCID: PMC7371037 DOI: 10.1097/corr.0000000000001368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/27/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Lars F H Theyse
- L. F. H. Theyse, College of Veterinary Medicine, University of Leipzig, Department for Small Animals, Soft Tissue and Orthopaedic Surgery Service, Leipzig, Germany
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Hamushan M, Cai W, Zhang Y, Lou T, Zhang S, Zhang X, Cheng P, Zhao C, Han P. High-purity magnesium pin enhances bone consolidation in distraction osteogenesis model through activation of the VHL/HIF-1α/VEGF signaling. J Biomater Appl 2020; 35:224-236. [PMID: 32460592 DOI: 10.1177/0885328220928550] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Distraction osteogenesis has widespread clinical use in the treatment of large bone defects. Nonetheless, the prolonged consolidation period carries the risk of complications. Magnesium-based materials have been shown to promote bone regeneration in fracture healing both in vitro and in vivo. Here, we investigated whether high-purity magnesium could enhance bone formation in distraction osteogenesis. High-purity magnesium pins were placed into the medullary cavity in the rat distraction osteogenesis model. Results showed that the bone volume/total tissue volume, bone mineral density, and mechanical properties of new callus were significantly higher in the high-purity magnesium group compared to stainless steel and control group (p < 0.01). Histological analyses confirmed improved bone consolidation and vascularization in high-purity magnesium group. Further, polymerase chain reaction-array investigation, Western blot, and immunohistochemical results found that vascular endothelial growth factor and hypoxia inducible factor-1α were highly expressed in the high-purity magnesium group, while Von Hippel–Lindau protein was the opposite (p < 0.01). In conclusion, high-purity magnesium implants have the potential to enhance angiogenesis and bone consolidation in the distraction osteogenesis application, and this process might be via the regulation of Von Hippel–Lindau/hypoxia inducible factor-1α/vascular endothelial growth factor signaling.
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Affiliation(s)
- Musha Hamushan
- Orthopaedic Department, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Weijie Cai
- Orthopaedic Department, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Yubo Zhang
- Orthopaedic Department, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Tengfei Lou
- Orthopaedic Department, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | | | - Xiaonong Zhang
- School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Pengfei Cheng
- Orthopaedic Department, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Changli Zhao
- School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Pei Han
- Orthopaedic Department, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
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Kanerva M, Pärnänen T, Jokinen J, Haaja J, Ritvanen A, Schlenzka D. Multi-Axis Fatigue Experimentation System of Intramedullary Implants for Femur and Tibia. J Orthop Res 2020; 38:984-995. [PMID: 31788838 PMCID: PMC7187242 DOI: 10.1002/jor.24545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 11/24/2019] [Indexed: 02/04/2023]
Abstract
Current designs of leg-lengthening implants have faced serious failures due to inadequacies in the mechanical design. The failure typically is the result of fatigue induced by a combined loading condition with axial and shear components acting in the tubular body of the implant. One of the reasons leading to the failure is improper verification testing for the design of the fatigue limit. The current test standards for pre-clinical design phases of nail implants are relatively straightforward and widely accepted yet cannot produce the three-dimensional stress state representative of the anticipated operation in a patient during the consolidation phase. This work introduces a major improvement toward a method for verifying fatigue life of tubular as well as solid implants under combined torque, axial load, and bending. The report describes a new loading fixture, a calibration method, and compares the qualification results of finite element simulation analyses and experimental measurements during cyclic loading tests. The findings state that the fixture produces controlled multi-axial loadings to study varied osteotomy locations, quasi-static strength and fatigue of intramedullary implants at an intermediate, 2 Hz, cycle rate. © 2019 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 38:984-995, 2020.
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Affiliation(s)
- Mikko Kanerva
- Faculty of Engineering and Natural SciencesTampere UniversityP.O.B 589FI‐33014TampereFinland
| | - Tuomas Pärnänen
- Faculty of Engineering and Natural SciencesTampere UniversityP.O.B 589FI‐33014TampereFinland,Orton Orthopaedic Hospital and Research Institute OrtonFI‐00280HelsinkiFinland
| | - Jarno Jokinen
- Faculty of Engineering and Natural SciencesTampere UniversityP.O.B 589FI‐33014TampereFinland
| | - Juha Haaja
- Synoste Oy, Metsänneidonkuja 6FI‐02130EspooFinland
| | | | - Dietrich Schlenzka
- Orton Orthopaedic Hospital and Research Institute OrtonFI‐00280HelsinkiFinland
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Lu Y, Ma T, Ren C, Li Z, Sun L, Xue H, Li M, Zhang K, Zhang C, Wang Q. Treatment of segmental tibial defects by bone transport with circular external fixation and a locking plate. J Int Med Res 2020; 48:300060520920407. [PMID: 32351151 PMCID: PMC7218946 DOI: 10.1177/0300060520920407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the effectiveness of bone transport involving circular external fixation and locking plate application for the treatment of segmental tibial defects. Methods A retrospective review of 12 patients with segmental tibial defects who underwent bone transport with circular external fixation and locking plate application. We evaluated external fixation time, external fixation index, time to achieve union, and complications. Clinical results were assessed using the Association for the Study and Application of the Methods of Ilizarov (ASAMI) score. Generic health-related outcome was assessed using the 36-Item Short-Form Health Survey questionnaire (SF-36). Results The mean follow-up was 25.8 months, and the mean defect size was 6.7 cm. All of the patients achieved union at the distraction callus and docking site. The average external fixation time was 299.5 days. The mean external fixation index was 16.5 days/cm, and the mean healing index was 44.9 days/cm. The functional outcomes were excellent in eight cases and good in four. The average SF-36 score was 92. Conclusion Bone transport with external fixation and locking plate application may be a promising method for the treatment of segmental tibial defects.
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Affiliation(s)
- Yao Lu
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Shan'xi, China
| | - Teng Ma
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Shan'xi, China
| | - Cheng Ren
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Shan'xi, China
| | - Zhong Li
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Shan'xi, China
| | - Liang Sun
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Shan'xi, China
| | - Hanzhong Xue
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Shan'xi, China
| | - Ming Li
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Shan'xi, China
| | - Kun Zhang
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Shan'xi, China
| | - Congming Zhang
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Shan'xi, China
| | - Qian Wang
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Shan'xi, China
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Kani KK, Porrino JA, Chew FS. External fixators: looking beyond the hardware maze. Skeletal Radiol 2020; 49:359-374. [PMID: 31515594 DOI: 10.1007/s00256-019-03306-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 08/25/2019] [Accepted: 08/27/2019] [Indexed: 02/02/2023]
Abstract
External fixation has a wide variety of orthopedic applications. Although external fixator frames may have a complex appearance, these constructs are formed from several basic components and can be broadly categorized into unilateral, circular, or hybrid designs. The introduction of computer-aided circular external fixation devices (hexapod frames) has simplified the treatment of multiaxial and especially rotational deformities. Serial radiography plays a central role in the evaluation of callus formation (at the level of treated fracture or nonunion as well as the regenerate and docking site with distraction osteogenesis), tailoring the rate and rhythm of distraction during distraction osteogenesis, evaluation of frame complications, and determination of the timing of frame removal. The goals of this article are to review: the components, types, and relevant terminology of external fixator constructs with special emphasis on the Taylor spatial frame, the principles and techniques of distraction osteogenesis, and complications of external fixation.
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Affiliation(s)
- Kimia Khalatbari Kani
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Jack A Porrino
- Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, 06520-8042, USA
| | - Felix S Chew
- Department of Radiology, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA, 98105, USA
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Sheridan GA, Falk DP, Fragomen AT, Rozbruch SR. Motorized Internal Limb-Lengthening (MILL) Techniques Are Superior to Alternative Limb-Lengthening Techniques. JB JS Open Access 2020. [DOI: 10.2106/jbjs.oa.20.00115] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Iliadis AD, Timms A, Fugazzotto S, Edel P, Britten S, Wright J, Goodier D, Calder P. Thromboprophylaxis in Intramedullary Limb Lengthening Surgery. Strategies Trauma Limb Reconstr 2020; 15:151-156. [PMID: 34025795 PMCID: PMC8121112 DOI: 10.5005/jp-journals-10080-1505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aim The use of intramedullary lengthening devices is becoming increasingly popular. There are limited data regarding the incidence of venous thromboembolism following intramedullary lengthening surgery and no reports or guidance for current practice on use of thromboprophylaxis. Following a case of post-operative deep vein thrombosis in our institution, we felt that it is important to assess best practice. We conducted a national survey to collect data that would describe current practice and help develop consensus for treatment. Materials and methods We identified surgeons across the UK that perform adult intramedullary limb lengthening through the British Limb Reconstruction Society membership and a Precise Users database. Surgeons were contacted and asked to respond to an online survey. Responses to thromboprophylaxis regimes employed in their practice and cases of venous thromboembolism were collated. Results 24 out of 54 surgeons identified responded with a total of 454 cases of adult intramedullary lengthening (352 femoral and 102 tibial nails) performed over a five year period (January 2015–January 2020). Only one case of deep venous thrombosis (DVT) following femoral lengthening was reported. There is wide variability in practice both in terms of thromboprophylaxis risk assessment, choice of medications and duration of treatment. The vast majority of surgeons (85%) felt that there was insufficient evidence available to guide their practice. Conclusions Intramedullary lengthening is a surgical treatment growing in popularity. There are limited data available to guide decision-making regarding aspects of treatment such as thromboprophylaxis. This is reflected in the wide variation in practice reported in this study. There are both a need and a desire to gather data that will allow us to come to a consensus and to guide safe practice. Clinical significance Venous thromboembolism is a potential complication of lower limb lengthening surgery. We report on national incidence and current practices of thromboprophylaxis to allow for informed decision-making and help develop consensus for best practice. How to cite this article Iliadis AD, Timms A, Fugazzotto S, et al. Thromboprophylaxis in Intramedullary Limb Lengthening Surgery. Strategies Trauma Limb Reconstr 2020;15(3):151-156.
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Affiliation(s)
- Alexios D Iliadis
- Limb Reconstruction Unit, Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
| | - Anna Timms
- Limb Reconstruction Unit, Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
| | - Sharron Fugazzotto
- Limb Reconstruction Unit, Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
| | - Penina Edel
- Limb Reconstruction Unit, Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
| | - Simon Britten
- Limb Reconstruction Unit, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Jonathan Wright
- Limb Reconstruction Unit, Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
| | - David Goodier
- Limb Reconstruction Unit, Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
| | - Peter Calder
- Limb Reconstruction Unit, Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
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Thaller PH, Frankenberg F, Degen N, Soo C, Wolf F, Euler E, Fürmetz J. Complications and Effectiveness of Intramedullary Limb Lengthening: A Matched Pair Analysis of Two Different Lengthening Nails. Strategies Trauma Limb Reconstr 2020; 15:7-12. [PMID: 33363635 PMCID: PMC7744673 DOI: 10.5005/jp-journals-10080-1448] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Intramedullary limb lengthening has become an accepted concept in reconstructive surgery, but as yet comparative clinical studies are missing. We compared the complications and effectiveness of two types of intramedullary limb lengthening devices (ISKD®; Fitbone®). Materials and methods In a retrospective series of 278 consecutive patients with internal limb lengthening, we found 17 matching pairs in terms of predefined matching parameters (group I with ISKD® and group II with Fitbone®). The surgeries were all performed with the same technique and managed with equivalent pre- and postoperative treatment protocols. The performance of the implants was evaluated using the distraction index and the weight-bearing index. Complications were rated according to Paley's classification for external lengthening. Results The distraction index in group I (ISKD®) was 0.99 mm/day (range 0.55-1.67) and in the group II (Fitbone®) 0.55 mm/day (range 0.14-0.92) (p value = 0.001). The mean weight-bearing index differed between group I and group II from 32.0 day/cm (range 16.4-64.0) to 51.6 day/cm (25.8-95.0) (p value = 0.001). There were 17 recorded incidents in group I and 19 in group II during lengthening. Conclusion Specific technical handicaps of the two systems, such as the so-called runaway of the ISKD® and backtracking of the Fitbone® nails seem to result in different distraction index and weight-bearing index. Further comparative studies might induce technical progress in intramedullary limb lengthening. How to cite this article Thaller PH, Frankenberg F, Degen N, et al. Complications and Effectiveness of Intramedullary Limb Lengthening: A Matched Pair Analysis of Two Different Lengthening Nails. Strategies Trauma Limb Reconstr 2020;15(1):7-12.
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Affiliation(s)
- Peter H Thaller
- 3DSurgery, Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, LMU, Germany
| | - Felix Frankenberg
- Department Trauma and Reconstructive Surgery, Klinikum München Süd, Germany
| | - Nikolaus Degen
- 3DSurgery, Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, LMU, Germany
| | - Chris Soo
- School of Medicine, Griffith University, Gold Coast, Australia
| | - Florian Wolf
- 3DSurgery, Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, LMU, Germany
| | - Ekkehard Euler
- 3DSurgery, Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, LMU, Germany
| | - Julian Fürmetz
- 3DSurgery, Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, LMU, Germany
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Calder PR, McKay JE, Timms AJ, Roskrow T, Fugazzotto S, Edel P, Goodier WD. Femoral lengthening using the Precice intramedullary limb-lengthening system. Bone Joint J 2019; 101-B:1168-1176. [DOI: 10.1302/0301-620x.101b9.bjj-2018-1271.r1] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Aims The Precice intramedullary limb-lengthening system has demonstrated significant benefits over external fixation lengthening methods, leading to a paradigm shift in limb lengthening. This study compares outcomes following antegrade and retrograde femoral lengthening in both adolescent and adult patients. Patients and Methods A retrospective review of prospectively collected data was undertaken of a consecutive series of 107 femoral lengthening operations in 92 patients. In total, 73 antegrade nails and 34 retrograde nails were inserted. Outcome was assessed by the regenerate healing index (HI), hip and knee range of movement (ROM), and the presence of any complications. Results The mean lengthening was 4.65 cm (1.5 to 8) in the antegrade group and 4.64 cm (1.6 to 8) in the retrograde group. Of the 107 lengthenings, 100 had sufficient datapoints to calculate the mean HI. This was 31.6 days/cm (15 to 108). There was a trend toward a lower (better) HI with an antegrade nail and better outcomes in adolescent patients, but these were not statistically significant. Hip and knee ROM was maintained and/or improved following commencement of femoral lengthening in 44 patients (60%) of antegrade nails and 13 patients (38%) of retrograde nails. In female patients, loss of movement occurred both earlier and following less total length achieved. Minor implant complications included locking bolt migration and in one patient deformity of the nail, but no implant failed to lengthen and there were no deep infections. Three patients had delayed union, five patients required surgical intervention for joint contracture. Conclusion This study confirms excellent results in femoral lengthening with antegrade and retrograde Precice nails. There is a trend for better healing and less restriction in hip and knee movement following antegrade nails. There are clinical scenarios, that mandate the use of a retrograde nail. However, when these are not present, we recommend the use of antegrade nailing. Cite this article: Bone Joint J 2019;101-B:1168–1176
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Affiliation(s)
| | | | - Anna J. Timms
- The Royal National Orthopaedic Hospital, Stanmore, UK
| | - Tracy Roskrow
- The Royal National Orthopaedic Hospital, Stanmore, UK
| | | | - Penina Edel
- The Royal National Orthopaedic Hospital, Stanmore, UK
| | - W. D. Goodier
- The Royal National Orthopaedic Hospital, Stanmore, UK
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Wolf F, Bösl S, Degen N, Fürmetz J, Thaller PH. Impacted Steel Sleeves for a minimally invasive approach in intramedullary nailing. Injury 2019; 50 Suppl 3:4-10. [PMID: 31445829 DOI: 10.1016/j.injury.2019.07.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A custom-made instrument set of Steel Sleeves was developed to assist the insertion of reamers and intramedullary devices for fixation of long bone fractures or lengthening procedures with intramedullary nails. By use of the Steel Sleeves, migration of the entry point is prevented and protection of the bone and soft tissue at the entry point is guaranteed. In addition, the principle of a closed working channel for trans-articular approaches can be provided. In this article, a description of properties and clinical application of custom-made steel sleeve instrument set is provided.
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Affiliation(s)
- F Wolf
- 3D-Surgery, Department of General- Trauma- and Reconstructive Surgery, University Hospital Ludwig-Maximilians-University (LMU), Munich, Germany.
| | - S Bösl
- 3D-Surgery, Department of General- Trauma- and Reconstructive Surgery, University Hospital Ludwig-Maximilians-University (LMU), Munich, Germany
| | - N Degen
- 3D-Surgery, Department of General- Trauma- and Reconstructive Surgery, University Hospital Ludwig-Maximilians-University (LMU), Munich, Germany
| | - J Fürmetz
- 3D-Surgery, Department of General- Trauma- and Reconstructive Surgery, University Hospital Ludwig-Maximilians-University (LMU), Munich, Germany
| | - P H Thaller
- 3D-Surgery, Department of General- Trauma- and Reconstructive Surgery, University Hospital Ludwig-Maximilians-University (LMU), Munich, Germany
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41
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Affiliation(s)
- Wilhelm Friedl
- Division of Orthopaedics and Trauma Surgery, Rotkreuzklinik Wertheim gGmbH, Rotkreuzstraße 2, D-97877, Wertheim am Main, Germany
| | - Georg Gradl
- Munich Municipal Hospital Group, Clinic for Trauma, Orthopedic Surgery, Hand Surgery Harlaching, 81545, München, Germany
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Thaller PH, Fürmetz J, Degen N, Eilers T, Euler E, Wolf F. Intraoperative customization of intramedullary nails - First results. Injury 2019; 50 Suppl 3:11-16. [PMID: 31378545 DOI: 10.1016/j.injury.2019.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Intramedullary nailing is a valuable treatment option for many types of fractures. Furthermore nailing is applicable for osteosynthesis following osteotomy in deformity correction. For intraoperative fine-tuning of alignment in intramedullary (IM) nailing procedures, a bending device for customization of IM nails under sterile conditions was developed. We have performed a retrospective clinical study to analyze and describe the technical requirements, indications and limitations for intraoperative customization of IM nails. MATERIALS AND METHODS In 41 cases of deformity correction with IM nailing, we applied intraoperative sterile bending of IM nails. The patient age ranged from 13 to 64 years. We evaluated the radiological outcome (precision of the intervention) of 31 completed cases, comparing the preoperative planning with the final result on long-standing radiographs (LSR). The diameter of the nails ranged from 8,5mm to 13mm. Cases with fracture or non-union treatment with intraoperative application of the bending device were excluded and analyzed separately. RESULTS All removed implants were examined - none of them showed any signs of material fatigue. The amount of intraoperative bending of the nails was 1° to 12°. A high level of precision was achieved, with a median postoperative axis deviation to the preoperative planning of 3,5mm. In a polio patient with limited bone quality, the implant removal caused an undisplaced cortical crack. There were no other complications. There was uneventful and fast bone healing in all patients. CONCLUSIONS Intraoperative customization of intramedullary nails is a valuable technique for precise alignment control with IM nailing. With this technique, the benefits of IM nailing can be used for a wide range of indications, including deformity correction. The sterile bending device is safe and easy to handle. It is strong enough to bend all commercially available IM nails. Monofocal or linear bending in multiple planes is possible. However, when defining the site of bending, one must consider the removal of the implant in the future.
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Affiliation(s)
- P H Thaller
- 3D-Surgery, Department of General- Trauma- and Reconstructive Surgery, University Hospital Ludwig-Maximilians-University (LMU), Munich, Germany
| | - J Fürmetz
- 3D-Surgery, Department of General- Trauma- and Reconstructive Surgery, University Hospital Ludwig-Maximilians-University (LMU), Munich, Germany
| | - N Degen
- 3D-Surgery, Department of General- Trauma- and Reconstructive Surgery, University Hospital Ludwig-Maximilians-University (LMU), Munich, Germany
| | - T Eilers
- 3D-Surgery, Department of General- Trauma- and Reconstructive Surgery, University Hospital Ludwig-Maximilians-University (LMU), Munich, Germany
| | - E Euler
- Department of General- Trauma- and Reconstructive Surgery, University Hospital Ludwig-Maximilians-University (LMU), Munich, Germany
| | - F Wolf
- 3D-Surgery, Department of General- Trauma- and Reconstructive Surgery, University Hospital Ludwig-Maximilians-University (LMU), Munich, Germany.
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Kanerva M, Besharat Z, Pärnänen T, Jokinen J, Honkanen M, Sarlin E, Göthelid M, Schlenzka D. Miniature CoCr laser welds under cyclic shear: Fatigue evolution and crack growth. J Mech Behav Biomed Mater 2019; 99:93-103. [PMID: 31349149 DOI: 10.1016/j.jmbbm.2019.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 06/26/2019] [Accepted: 07/07/2019] [Indexed: 11/30/2022]
Abstract
Miniature laser welds with the root depth in the range of 50-300 μm represent air-tight joints between the components in medical devices, such as those in implants, growth rods, stents and various prostheses. The current work focuses on the development of a fatigue test specimen and procedure to determine fatigue lives of shear-loaded laser welds. A cobalt-chromium (CoCr) alloy is used as a benchmark case. S-N graphs, damage process, and fracture surfaces are studied by applying x-ray analysis, atomic force microscopy, and scanning electron microscopy both before and after the crack onset. A non-linear material model is fitted for the CoCr alloy to run finite element simulations of the damage and deformation. As a result, two tensile-loaded specimen designs are established and the performance is compared to that of a traditional torque-loaded specimen. The new generation specimens show less variation in the determined fatigue lives due to well-defined crack onset point and, therefore, precise weld seam load during the experiments. The fatigue damage concentrates to the welded material and the entire weld experiences fatigue prior to the final, fracture-governed failure phase. For the studied weld seams of hardened CoCr, a regression fatigue limit of 10.8-11.8 MPa, where the stress refers to the arithmetic average shear stress computed along the region dominated by shear loading, is determined.
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Affiliation(s)
- M Kanerva
- Tampere University, Faculty of Engineering and Natural Sciences, P.O.Box 589, FI-33014, Tampere, Finland; Orton Orthopaedic Hospital and Research Institute Orton, FI-00280, Helsinki, Finland.
| | - Z Besharat
- Royal Institute of Technology, Surface and Corrosion Science, P.O.Box 10044, SE-16440, Stockholm, Sweden
| | - T Pärnänen
- Orton Orthopaedic Hospital and Research Institute Orton, FI-00280, Helsinki, Finland
| | - J Jokinen
- Tampere University, Faculty of Engineering and Natural Sciences, P.O.Box 589, FI-33014, Tampere, Finland
| | - M Honkanen
- Tampere University, Faculty of Engineering and Natural Sciences, P.O.Box 589, FI-33014, Tampere, Finland
| | - E Sarlin
- Tampere University, Faculty of Engineering and Natural Sciences, P.O.Box 589, FI-33014, Tampere, Finland
| | - M Göthelid
- Royal Institute of Technology, Surface and Corrosion Science, P.O.Box 10044, SE-16440, Stockholm, Sweden
| | - D Schlenzka
- Orton Orthopaedic Hospital and Research Institute Orton, FI-00280, Helsinki, Finland
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Calder PR, Faimali M, Goodier WD. The role of external fixation in paediatric limb lengthening and deformity correction. Injury 2019; 50 Suppl 1:S18-S23. [PMID: 30987743 DOI: 10.1016/j.injury.2019.03.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 03/28/2019] [Indexed: 02/06/2023]
Abstract
Limb deformity and shortening remains a common presenting complaint in paediatric orthopaedics. The ability to restore length, alignment with consistent bone formation allows standardised treatment in these difficult conditions. The use of an external fixator produces a stable construct which allows manipulation of the bone segments, with a controlled rate and rhythm. Deformity analysis permits the surgeon to plan osteotomy levels and frame application to produce accurate correction. Complications, especially in congenital conditions remain an issue and modification of the treatment is required to try and reduce their incidence. New types of fixators, the latest being hexapod frames, have increased the versatility in deformity correction. The aim of this paper is to review the use of external fixators in elective paediatric orthopaedics and highlight the latest changes in technique and application for the limb reconstruction surgeon.
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Affiliation(s)
- Peter R Calder
- The Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK.
| | - Martina Faimali
- The Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
| | - W David Goodier
- The Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
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Goodier WD, Calder PR. External fixation for the correction of adult post-traumatic deformities. Injury 2019; 50 Suppl 1:S36-S44. [PMID: 31054864 DOI: 10.1016/j.injury.2019.03.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 03/28/2019] [Indexed: 02/02/2023]
Abstract
Malalignment of the lower limb is a significant factor in the progression of arthritis of the knee and ankle, and correction of deformity can slow the progress and reduce symptoms. It is less clear that malalignment can cause arthritis de novo, but in post traumatic deformity it has been shown that a fracture of the tibia can increase the risk of pain and stiffness of the knee and ankle irrespective of deformity. The management of deformity of the lower limb by external fixation requires a careful systematic method of deformity analysis combining clinical and radiographic assessment is essential to avoid the pitfalls of overlooking potential soft tissue problems, and hidden secondary deformities. External fixators are powerful tools for the correction of deformity, but a sound grounding in deformity analysis is essential.
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Affiliation(s)
- W David Goodier
- The Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK.
| | - Peter R Calder
- The Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK
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46
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Popkov A, Dučić S, Lazović M, Lascombes P, Popkov D. Limb lengthening and deformity correction in children with abnormal bone. Injury 2019; 50 Suppl 1:S79-S86. [PMID: 30987742 DOI: 10.1016/j.injury.2019.03.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 03/28/2019] [Indexed: 02/08/2023]
Abstract
Flexible intramedullary nailing (FIN) provides multiple advantages in limb lengthening and progressive deformity correction in combination with external fixation. The article presents brief literature review and authors' experience in limb lengthening of abnormal bone (Ollier's disease, fibrous dysplasia, osteogenesis imperfecta). Titanium and, especially, hydroxyapatite-coated bent elastic nails in combination with external fixator are appropriate in limb lengthening of abnormal bone in children. FIN left in situ after lengthening procedure and external frame removal should be applied for long-term reinforcement of lengthened bone in patients with abnormal bone (metabolic bone disorders, skeletal dysplasias with compromised bone tissue development). The FIN respects bone biology, which is mandatory for good bone consolidation. Osteoactive properties of intramedullary elastic implants are favorable for bone formation and as well as for stable position of nails without risks of migration in long-term follow-up.
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Affiliation(s)
- Arnold Popkov
- Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, 6, M. Ulyanova Street, 640014, Kurgan, Russian Federation
| | - Siniša Dučić
- Children's University Hospital, Tiršova 10, Belgrade, Serbia
| | - Mikan Lazović
- Children's University Hospital, Tiršova 10, Belgrade, Serbia
| | - Pierre Lascombes
- Division of Paediatric Orthopaedics, Hôpitaux Universitaires de Genève, rue Willy Donzé 6, CH - 1211, Geneva 14, Switzerland
| | - Dmitry Popkov
- Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, 6, M. Ulyanova Street, 640014, Kurgan, Russian Federation.
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Wright J, Bates P, Heidari N, Vris A. All Internal Bone Transport: Use of a Lengthening Nail and Double Plating for Management of Femoral Bone Loss. Strategies Trauma Limb Reconstr 2019; 14:94-101. [PMID: 32742421 PMCID: PMC7376584 DOI: 10.5005/jp-journals-10080-1431] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background Variety of techniques for management of segmental femoral bone loss have been described, each with different advantages and challenges during treatment. The development of motorized lengthening nails has provided a potential for all internal bone transport, avoiding some of the difficulties with external fixation in the femur. At present, there is limited published literature on experiences in this technique. Aim The development of this technique aimed to overcome the difficulties previously reported for internal bone transport in the femur, particularly varus deformity and joint stiffness. Technique We describe the technique of double plating with bone transport utilizing a magnetic lengthening nail to manage segmental femoral bone loss. The benefits of the technique are discussed, along with specific challenges and lessons that have been learned through experience of internal bone transport. Conclusion Use of a magnetic lengthening nail and double plating as a method of all internal bone transport provides an option for the management of massive femoral bone loss, while avoiding some of the challenges that have been reported with the existing techniques. Clinical significance This technique provides an additional method in the armamentarium of the trauma or limb reconstruction surgeon treating massive femoral bone loss. How to cite this article Wright J, Bates P, Heidari N, et al. All Internal Bone Transport: Use of a Lengthening Nail and Double Plating for Management of Femoral Bone Loss. Strategies Trauma Limb Reconstr 2019;14(2):94–101.
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Affiliation(s)
- Jonathan Wright
- Department of Paediatric Orthopaedics and Limb Reconstruction, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Peter Bates
- Department of Trauma and Orthopaedics, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Nima Heidari
- Department of Trauma and Orthopaedics, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Alexandros Vris
- Department of Trauma and Orthopaedics, The Royal London Hospital, Barts Health NHS Trust, London, UK
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Lopes M, Nunes B, Couto A, Freitas J, Martins R, Coutinho J, Costa G. Electromagnetic Rod in Lower Limb Lengthening: A Technical Note for Shaft Osteotomy. Strategies Trauma Limb Reconstr 2019; 14:139-141. [PMID: 32742429 PMCID: PMC7368354 DOI: 10.5005/jp-journals-10080-1444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Long bone lengthening procedures are paramount in the treatment of limb length discrepancies. We witnessed a revolution in the treatment paradigm of this pathology with the development of expandable intramedullary rods. Endomedular nailing might be technically demanding and some steps are critical for success. The aim of authors is to describe a technical note of the PRECICE system that may ease femoral nailing and fixation: the nail can be advanced through the femur and proximal and distal fixation performed previous to complete femoral osteotomy. Materials and methods The authors present a case series of XX patients in which the limb lengthening has been performed with partial osteotomy with Gigli saw, nail advancement, proximal and distal fixation, and osteotomy completion at the end of the procedure. Results After 18 consecutive limb (femoral) lengthening operations with this technical variation in PRECICE, nail patients presented no significant lower limb length discrepancy. There were no records of rotational deformities, nonunion, or infection. Material failure was not reported. Conclusion This technical note is another positive variable that can help to ease the procedure, minimise possible complications, and confirm magnetic expandable nails as the gold standard technique in limb lengthening procedures and it might be applied to other nailing systems for limb lengthening procedures. How to cite this article Lopes M, Nunes B, Couto A, et al. Electromagnetic Rod in Lower Limb Lengthening: A Technical Note for Shaft Osteotomy. Strategies Trauma Limb Reconstr 2019;14(3):139–141.
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Affiliation(s)
- Miguel Lopes
- Department of Orthopaedic and Traumatology, Centro Hospitalar de São João, Porto, Portugal
| | - Bernardo Nunes
- Department of Orthopaedic and Traumatology, Centro Hospitalar de São João, Porto, Portugal
| | - André Couto
- Department of Orthopaedic and Traumatology, Centro Hospitalar de São João, Porto, Portugal
| | - Joana Freitas
- Department of Orthopaedic and Traumatology, Centro Hospitalar de São João, Porto, Portugal
| | - Rui Martins
- Department of Orthopaedic and Traumatology, Centro Hospitalar de São João, Porto, Portugal
| | - Jorge Coutinho
- Department of Orthopaedic and Traumatology, Centro Hospitalar de São João, Porto, Portugal
| | - Gilberto Costa
- Department of Orthopaedic and Traumatology, Centro Hospitalar de São João, Porto, Portugal
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Park KB, Kwak YH, Lee JW, Park BK, Park H, Lee DH. Functional recovery of daily living and sports activities after cosmetic bilateral tibia lengthening. INTERNATIONAL ORTHOPAEDICS 2018; 43:2017-2023. [PMID: 30311058 DOI: 10.1007/s00264-018-4159-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 09/12/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE The aims of this study were to evaluate the recovery of physical function and to investigate whether there are factors that adversely affect functional recovery after cosmetic bilateral lengthening of the tibia. METHODS One hundred twenty-five healthy individuals who had undergone bilateral cosmetic tibia lengthening by the lengthening and then nail (LATN) method, lengthening over intramedullary nail (LON) method or intramedullary skeletal kinetic distractor (ISKD) were included in the study. Functional outcomes were evaluated using the Sports Activity Rating Scale (SARS), International Knee Documentation Committee (IKDC) Subjective Knee Form and patient self-reported ability scores. RESULTS SARS and IKDC scores decreased at post-operative one year and improved significantly at post-operative two years. SARS and IKDC scores recovered similarly to pre-operative levels. Average patient self-reported ability scores at post-operative two years were 94.6 and 89.9 for daily living and light sports, respectively. However, the average score for moderate-to-strenuous sports was 68.1 and 39 patients (31.2%) recorded below average score for the moderate-to-strenuous sports. CONCLUSIONS Patients who had undergone bilateral cosmetic tibial lengthening may expect almost full recovery of daily and light sports activities at post-operativetwo years. However, several patients may feel some limitation in moderate-to-strenuous sports activities.
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Affiliation(s)
- Kun-Bo Park
- Division of Orthopedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Yoon Hae Kwak
- Department of Orthopaedic Surgery, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Jung Woo Lee
- Division of Orthopedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Byoung Kyu Park
- Division of Orthopedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Hoon Park
- Division of Orthopedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Dong Hoon Lee
- Division of Orthopedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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Two consecutive limb lengthenings with the same PRECICE nail: a technical note. Strategies Trauma Limb Reconstr 2018; 13:199-204. [PMID: 30232655 PMCID: PMC6249150 DOI: 10.1007/s11751-018-0317-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 09/11/2018] [Indexed: 01/14/2023] Open
Abstract
Purpose The most significant advance in our time about limb lengthening is the magnetic lengthening nail, as the first reports appeared to show good results with accurate lengthening rates and good regenerate bone formation. The described complication rate is generally low. They avoid external fixation elements, and are activated transcutaneously, so the patient’s pain and discomfort are reduced and the rehabilitation is faster and more effective. The aim of authors is to describe a special technical issue of the PRECICE system: the nail can be extended inside the patient limb (after the osteotomy), but it also can be retracted inside the limb after achieving the bone union. Methods The authors present a case in which the limb lengthening has been performed in consecutive lengthening periods using the same nail. The nail was extended and retracted by altering the settings on the external remote control as well as accurately setting the rate of distraction. Results After two consecutive femoral lengthening with the same PRECICE nail, the patient no longer has a significant lower limb length discrepancy and patient satisfaction was high. During this clinical case, we were not confronted with any type of complications. Conclusion This technique utilizes the principles and advantages of lengthening over an magnetic lengthening nail, avoids the necessity of nail removal and minimizes the complication rates and the overall time for complete recovery. Level of evidence Level IV.
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