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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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Femino JD, Barnes SR, Nelson SC, Zuckerman LM. Clinical compatibility of magnetic resonance imaging with magnetic intramedullary nails: a feasibility study. Arch Orthop Trauma Surg 2024; 144:1503-1509. [PMID: 38353685 PMCID: PMC10965604 DOI: 10.1007/s00402-024-05210-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 01/21/2024] [Indexed: 03/27/2024]
Abstract
INTRODUCTION The use of magnetic resonance imaging (MRI) with a magnetic intramedullary lengthening nail in place is contraindicated per the manufacturer due to the concern of implant activation and migration. A prior in vitro study did not confirm these complications only noting that a 3.0 T MRI weakened the internal magnet. Therefore, a retrospective analysis of patients who underwent an MRI with a magnetic nail in place was performed to determine if any adverse effects occurred in the clinical setting. MATERIALS AND METHODS A retrospective review of all patients who underwent an MRI with a magnetic lengthening nail in place was performed. The time spent being imaged in the MRI, number of times the patient entered the MRI suite, and the images obtained were recorded. Radiographs were performed before and after the MRI to determine if any hardware complications occurred. The patients were monitored for any adverse symptoms while they were in the suite. RESULTS A total of 12 patients with 13 nails were identified. Two patients underwent imaging with a 3.0 T MRI while the remaining 10 underwent imaging with a 1.5 T MRI. Each patient entered the MRI suite 2.1 times and spent an average of 84.7 min being imaged in the MRI (range 21-494). No patients noted any adverse symptoms related to the nail while in the suite and no hardware complications were identified. CONCLUSION MRI appears to be safe with a magnetic nail in place and did not result in any complications. Given the manufacturer's recommendations, informed consent should be obtained prior to an MRI being performed and a 3.0 T MRI should be avoided when possible if further activation of the nail is required.
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Affiliation(s)
- Joseph D Femino
- Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, 1520 San Pablo St., Suite 2000, Los Angeles, CA, 90033, USA
| | - Samuel R Barnes
- Department of Radiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Scott C Nelson
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Lee M Zuckerman
- Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, 1520 San Pablo St., Suite 2000, Los Angeles, CA, 90033, USA.
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Vogt B, Laufer A, Gosheger G, Toporowski G, Antfang C, Rölfing JD, Rödl R, Frommer A. Evaluation of simultaneous bilateral femoral distraction osteogenesis with antegrade intramedullary lengthening nails in achondroplasia with rhizomelic short stature: a retrospective study of 15 patients with a minimum follow-up of 2 years. Acta Orthop 2024; 95:47-54. [PMID: 38287909 PMCID: PMC10825798 DOI: 10.2340/17453674.2024.35226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 11/07/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND AND PURPOSE Bilateral femoral distraction osteogenesis in patients with achondroplasia is insufficiently reported. We aimed to perform the first study that exclusively analyzed simultaneous bilateral femoral distraction osteogenesis with motorized intramedullary lengthening nails via an antegrade approach in patients with achondroplasia focused on reliability, accuracy, precision, and the evolving complications. PATIENTS AND METHODS In this retrospective singlecenter study we analyzed patients with achondroplasia who underwent simultaneous bilateral femoral lengthening with antegrade intramedullary lengthening nails between October 2014 and April 2019. 15 patients (30 femoral segments) of median age 14 years (interquartile range [IQR] 12-15) were available for analysis. The median follow-up was 29 months (IQR 27-37) after nail implantation. RESULTS The median distraction length per segment was 49 mm (IQR 47-51) with a median distraction index of 1.0 mm/day (IQR 0.9-1.0), and a median consolidation index of 20 days/cm (IQR 17-23). Reliability of the lengthening nails was 97% and their calculated accuracy and precision were 96% and 95%, respectively. The most common complication was temporary restriction of knee range of motion during distraction in 10 of 30 of the lengthened segments. 1 patient was treated with 2 unplanned additional surgeries due to premature consolidation. CONCLUSION The method is reliable and accurate with few complications.
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Affiliation(s)
- Björn Vogt
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Muenster, Germany; General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany.
| | - Andrea Laufer
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Muenster, Germany; General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Georg Gosheger
- General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Gregor Toporowski
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Muenster, Germany; General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Carina Antfang
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Muenster, Germany; General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Jan Duedal Rölfing
- Children's Orthopedics and Reconstruction, Aarhus University Hospital, Aarhus, Denmark
| | - Robert Rödl
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Muenster, Germany; General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Adrien Frommer
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Muenster, Germany; General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
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FROST MW, RAHBEK O, IOBST C, BAFOR A, DUNCAN M, KOLD S. Complications and risk factors of intramedullary bone lengthening nails: a retrospective multicenter cohort study of 314 FITBONE and PRECICE nails. Acta Orthop 2023; 94:51-59. [PMID: 36807707 PMCID: PMC9940487 DOI: 10.2340/17453674.2023.8479] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND AND PURPOSE Intramedullary bone-lengthening nails have become increasingly popular. The 2 most used and successful nails are the FITBONE and the PRECICE nails. Uniform reporting is lacking on complications of intramedullary bone-lengthening nails. The purpose was therefore to assess and categorize the complications of lower limb bone-lengthening nails and investigate risk factors. PATIENTS AND METHODS We performed a retrospective review of patients operated on with intramedullary lengthening nails at 2 hospitals. We included only lower limb lengthening with FITBONE and PRECICE nails. Recorded patient data was patient demographics, nail information, and any complication. Complications were graded according to severity and origin classification. Complication risk factors were assessed with modified Poisson regression. RESULTS 314 segments in 257 patients were included. The FITBONE nail was predominantly used (75%), and most of the lengthenings were performed in the femur (80%). 53% of the patients had complications. 269 complications were identified in 175 segments (144 patients). Device-related complications were most frequent (0.3 complications/segment), followed by joint complications (0.2 complications/segment). An increased relative risk was found for complications in the tibia compared with the femur and for age groups above 30 years compared with the 10-19 years group. CONCLUSION Complications with intramedullary bone lengthening nails were more frequent than has previously been reported, with 53% of patients sustaining a complication. Future studies need to document the complications meticulously so that the true risk can be established.
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Affiliation(s)
- Markus W FROST
- Department of Orthopedic Surgery, Aalborg University Hospital; Aalborg,Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Ole RAHBEK
- Department of Orthopedic Surgery, Aalborg University Hospital; Aalborg,Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Christopher IOBST
- Department of Orthopaedic Surgery, Center for Limb Lengthening and Reconstruction, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Anirejuoritse BAFOR
- Department of Orthopaedic Surgery, Center for Limb Lengthening and Reconstruction, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Molly DUNCAN
- Department of Orthopaedic Surgery, Center for Limb Lengthening and Reconstruction, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Søren KOLD
- Department of Orthopedic Surgery, Aalborg University Hospital; Aalborg,Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Hlukha LP, Alrabai HM, Sax OC, Hammouda AI, McClure PK, Herzenberg JE. Mechanical Failures in Magnetic Intramedullary Lengthening Nails. J Bone Joint Surg Am 2023; 105:113-127. [PMID: 36651888 DOI: 10.2106/jbjs.22.00283] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Magnetic intramedullary lengthening nails (MILNs) have gained popularity in recent years for the treatment of limb-lengthening discrepancies. We sought to catalog mechanical failures and their prevention and management in a large, single-institution series. We specifically assessed the rate of mechanical failures, the types of failures observed, and management strategies. METHODS We retrospectively reviewed 377 patients (420 limbs) who underwent limb lengthening with early (P1) or later (P2) MILN iterations with ≥12-month follow-up. Mechanical failure was defined as mechanical breakage of the instrumentation or nail and/or failure of the internal lengthening mechanism. Failure assessment was arranged by lengthening phases and was sorted with a complication classification system. All lengthening and alignment parameters were assessed radiographically. RESULTS Mechanical failure was observed in 40 nails (9.5%), most of which (63%) were corrected with an additional surgical procedure. The mechanical failure rate was 11.3% in P1 nails and 9% in P2 nails. Two nails failed the intraoperative distraction test, and 1 nail was found to have a broken washer during the insertion phase. Sixteen nails had mechanical failures in the lengthening phase. Some nails (8 of 16) required nail replacement surgery. Thirteen nails failed during the consolidation phase; 7 of these cases were managed by replacement with either a functional MILN or a conventional intramedullary nail. Eight failures happened during the extraction phase and were managed intraoperatively. CONCLUSIONS A 9.5% overall rate of mechanical failure of MILNs was observed in this large series. Resolution was achieved with an additional surgery in most cases. Nail distraction and weight-bearing compliance should be closely monitored during the lengthening and consolidation phases. Nail removal can be difficult and requires a careful study of radiographs for locking-screw bone overgrowth and backup removal equipment. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Larysa P Hlukha
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Hamza M Alrabai
- Department of Orthopedics, King Saud University, Riyadh, Saudi Arabia
| | - Oliver C Sax
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Ahmed I Hammouda
- Department of Orthopedic Surgery, Al-Azhar University, Cairo, Egypt
| | - Philip K McClure
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - John E Herzenberg
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
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Bafor A, Iobst CA. What's New in Limb Lengthening and Deformity Correction. J Bone Joint Surg Am 2022; 104:1419-1425. [PMID: 35703147 DOI: 10.2106/jbjs.22.00398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Anirejuoritse Bafor
- Department of Orthopedic Surgery, Nationwide Children's Hospital, Columbus, Ohio
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