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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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Iobst CA, Hatfield DN, Forro SD, Quinnan SM. Magnetically Driven Intramedullary Limb Lengthening in Patients with Pre-existing Implanted Programmable Devices: A Case Series. Strategies Trauma Limb Reconstr 2023; 18:111-116. [PMID: 37942430 PMCID: PMC10628617 DOI: 10.5005/jp-journals-10080-1590] [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: 03/25/2022] [Accepted: 04/03/2023] [Indexed: 11/10/2023] Open
Abstract
Aim The aim of the study is to demonstrate the safety and efficacy of the use of magnetically controlled intramedullary nails in patient with programmable implantable devices. Background Magnetically driven intramedullary limb lengthening devices have revolutionised the field of limb reconstruction. Because the system is powered by strong magnets, there are warnings to avoid the use of the device in patients with implanted programmable devices, such as cardiac pacemakers. Materials and methods Four patients with three different types of programmable implanted devices presented to two centres for limb lengthening and limb reconstruction. Each patient had a limb length discrepancy and desired correction using an intramedullary lengthening device. After thorough counselling about the potential risks and benefits of the procedure as well as discussions with each patient's medical team, the decision to proceed with surgery was made. Results All four patients underwent osteoplasty with insertion of a magnetically driven intramedullary lengthening nail. Goal length was achieved with successful consolidation and subsequent nail removal in all patients. There were no malfunctions of the implantable devices during the distraction phase in any of the patients. Conclusion With proper precautions, intramedullary lengthening can be performed safely and successfully using a magnetically driven nail in patients with previously implanted programmable devices. Clinical significance This initial experience suggests use of magnetically controlled intramedullary nails in patient with programmable implantable devices can be undertaken safely within constraints of precautions. How to cite this article Iobst CA, Hatfield DN, Forro SD, et al. Magnetically Driven Intramedullary Limb Lengthening in Patients with Pre-existing Implanted Programmable Devices: A Case Series. Strategies Trauma Limb Reconstr 2023;18(2):111-116.
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Affiliation(s)
- Christopher A Iobst
- Department of Orthopaedic Surgery, Nationwide Children's Hospital, Columbus, Ohio, United States
| | - Danielle N Hatfield
- Department of Orthopaedic Surgery, Nationwide Children's Hospital, Columbus, Ohio, United States
| | - Stephen D Forro
- Department of Orthopaedic Surgery, Nova University College of Osteopathic Medicine, United States
| | - Stephen M Quinnan
- Paley Orthopedic & Spine Institute, St. Mary's Medical Center, Palm Beach, Florida, United States
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Copp J, Magister S, Napora J, Getty P, Sontich J. Dual Magnetically Expandable Intramedullary Nails for Treatment of a Large Bony Defect in a Patient with Sarcoma: A Case Report. Strategies Trauma Limb Reconstr 2022; 17:189-194. [PMID: 36756295 PMCID: PMC9886027 DOI: 10.5005/jp-journals-10080-1560] [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: 05/31/2021] [Accepted: 06/16/2022] [Indexed: 01/01/2023] Open
Abstract
Aim To describe the surgical technique of performing an all-internal lengthening to address a large diaphyseal femur defect in the sarcoma patient. Background Various strategies exist to address large intercalary bone defects with various biomechanical and biological implications. Case description A 23-year-old female with high-grade osteosarcoma of her left femur underwent wide resection and an internal reconstruction of a 12.5-cm femoral defect using dual magnetic lengthening intramedullary nails resulting in restoration of leg lengths, and pre-resection function with minimal residual disability. Conclusion Preoperative chemotherapy, wide resection and post-operative chemotherapy for osteosarcoma are the current standard of care. Resection often leads to large bone defects requiring complex reconstruction. Following intercalary bone resection, biological reconstruction is a consideration. An all-inside technique was developed in an effort to minimise complications of long-term external fixation for distraction osteogenesis, or extensile secondary grafting procedures for induced membrane strategy. Clinical significance This previously unreported surgical technique allows for an all-internal lengthening of large diaphyseal bone defects. While specifically used in an oncologic post-resection setting, this technique is applicable to the broader limb reconstruction and lengthening practice and overcomes some inherent limitations to previously described techniques. How to cite this article Copp J, Magister S, Napora J, et al. Dual Magnetically Expandable Intramedullary Nails for Treatment of a Large Bony Defect in a Patient with Sarcoma: A Case Report. Strategies Trauma Limb Reconstr 2022;17(3):189-194.
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Affiliation(s)
- Jonathan Copp
- Department of Orthopaedics, University Hospitals, Cleveland, Ohio, United States of America
| | - Steven Magister
- Department of Orthopaedics, University Hospitals, Cleveland, Ohio, United States of America
| | - Joshua Napora
- Department of Orthopaedics, University Hospitals, Cleveland, Ohio, United States of America
| | - Patrick Getty
- Department of Orthopaedics, University Hospitals, Cleveland, Ohio, United States of America
| | - John Sontich
- Department of Orthopaedics, University Hospitals, Cleveland, Ohio, United States of America
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Intramedullary Fixation of Double-Barrel Vascularised Fibula Grafts With Subsequent Lengthening for Reconstruction of the Distal Femur in Patients With Osteosarcoma. J Pediatr Orthop 2022; 42:e674-e681. [PMID: 35667056 DOI: 10.1097/bpo.0000000000002147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The use of vascularised fibula grafts is an accepted method for reconstructing the distal femur following resection of malignant childhood tumors. Limitations relate to the mismatch of the cross-sectional area of the transplanted fibula graft and the local bone, instability of the construct and union difficulties. We present midterm results of a unique staged technique-an immediate defect reconstruction using a double-barrel vascularised fibula graft set in in A-frame configuration and a subsequent intramedullary femoral lengthening. METHODS We retrospectively included 10 patients (mean age 10 y) with an osteosarcoma of the distal femur, who were treated according to the above-mentioned surgical technique. All patients were evaluated with regards to consolidation of the transplanted grafts, hypertrophy at the graft-host junctions, leg length discrepancies, lengthening indices, complications as well as functional outcome. RESULTS The mean defect size after tumor resection was 14.5 cm, the mean length of the harvested fibula graft 22 cm, resulting in a mean (acute) shortening of 4.7 cm (in 8 patients). Consolidation was achieved in all cases, 4 patients required supplementary bone grafting. Hypertrophy at the graft-host junctions was observed in 78% of the evaluable junctions. In total 11 intramedullary lengthening procedures in 9 patients had been performed at the last follow up. The mean Muskuloskeletal Society Rating Scale (MSTS) score of the evaluable 9 patients was 85% (57% to 100%) with good or excellent results in 7 patients. CONCLUSIONS A-frame vascularised fibula reconstructions showed encouraging results with respect to defect reconstruction, length as well as function and should therefore be considered a valuable option for reconstruction of the distal femur after osteosarcoma resection. The surgical implementation is demanding though, which is emphasized by the considerable high number of complications requiring surgical intervention, even though most were not serious. LEVEL OF EVIDENCE Level IV-case series.
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Wooldridge J, Arduino A, Zilberti L, Zanovello U, Chiampi M, Clementi V, Bottauscio O. Gradient coil and radiofrequency induced heating of orthopaedic implants in MRI: influencing factors. Phys Med Biol 2021; 66. [PMID: 34847533 DOI: 10.1088/1361-6560/ac3eab] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 11/30/2021] [Indexed: 11/12/2022]
Abstract
Patients with implanted orthopaedic devices represent a growing number of subjects undergoing magnetic resonance imaging (MRI) scans each year. MRI safety labelling is required for all implants under the EU Medical Device Regulations to ensure regulatory compliance, with each device assessed through standardised testing procedures. In this paper, we employ parametric studies to assess a range of clinically relevant factors that cause tissue heating, performing simulations with both radiofrequency (RF) and gradient coil (GC) switching fields, the latter of which is often overlooked in the literature. A series of 'worst-case' scenarios for both types of excitation field is discussed. In the case of GC fields, large volume implants and large plate areas with the field orientated perpendicular to the plane cause the highest heating levels, along with sequences with high rates of field switching. Implant heating from RF fields is driven primarily from the 'antenna effect', with thin, linear implants of resonant length resulting in the highest temperature rises. In this work, we show that simplifications may be made to the field sequence and in some cases the device geometry without significantly compromising the accuracy of the simulation results, enabling the possibility for generic estimates of the implant heating for orthopaedic device manufacturers and opportunities to simplify the safety compliance process.
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Affiliation(s)
- J Wooldridge
- National Physical Laboratory, Hampton Road, Teddington, Middlesex, TW11 0LW, United Kingdom
| | - A Arduino
- Istituto Nazionale di Ricerca Metrologica, Str. delle Cacce, 91, I-10135 Torino TO, Italy
| | - L Zilberti
- Istituto Nazionale di Ricerca Metrologica, Str. delle Cacce, 91, I-10135 Torino TO, Italy
| | - U Zanovello
- Istituto Nazionale di Ricerca Metrologica, Str. delle Cacce, 91, I-10135 Torino TO, Italy
| | - M Chiampi
- Istituto Nazionale di Ricerca Metrologica, Str. delle Cacce, 91, I-10135 Torino TO, Italy
| | - V Clementi
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Tecnologia Medica, Via di Barbiano 1/10, I-40136 Bologna, Italy
| | - O Bottauscio
- Istituto Nazionale di Ricerca Metrologica, Str. delle Cacce, 91, I-10135 Torino TO, Italy
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Pietrzak S, Grzelecki D, Parol T, Czubak J. Comparison of Intramedullary Magnetic Nail, Monolateral External Distractor, and Spatial External Fixator in Femur Lengthening in Adolescents with Congenital Diseases. J Clin Med 2021; 10:jcm10245957. [PMID: 34945254 PMCID: PMC8706718 DOI: 10.3390/jcm10245957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/09/2021] [Accepted: 12/16/2021] [Indexed: 11/25/2022] Open
Abstract
The aim of this study is to evaluate the course of the treatment and clinical and functional outcomes of femur lengthening in adolescents with congenital disorders by the application of different surgical methods. This retrospective study comprised 35 patients (39 procedures). A total of 11 patients underwent femur lengthening with the use of the intramedullary magnetic nail (IMN) Precise 2 (NuVasive, San Diego, CA, USA), 7 patients (11 procedures) with the use of the monolateral external distractor Modular Rail System (MRS) (Smith and Nephew, Memphis, TN, USA), and 17 with the use of the computer-assisted external fixator Taylor Spatial Frame (TSF) (Smith and Nephew, Memphis, TN, USA). The inclusion criteria were as follows: (1) congenital femoral length deficiency without any axial deformities and (2), independently of the finally applied treatment, the technical possibility of use of each of the analyzed methods. The distraction index did not differ significantly between the groups (p = 0.89). The median lengthening index was the lowest in the IMN group (24.3 d/cm; IQR 21.8–33.1) and statistically different in comparison to the MRS (44.2 d/cm; IQR 42–50.9; p < 0.001) and the TSF groups (48.4 d/cm; IQR 38.6–63.5; p < 0.001). Similarly, the consolidation index in the IMN group (12.9 d/cm; IQR 10.7–21.3) was statistically lower than that in the MRS (32.9 d/cm; IQR 30.2–37.6; p < 0.001) and the TSF (36.9 d/cm; IQR 26.6–51.5; p < 0.001) groups. This study indicates that IMN is a more valuable method of treatment for femoral length discrepancy without axial deformity than MRS and TSF in complication rate and indexes of lengthening and consolidation.
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Affiliation(s)
- Szymon Pietrzak
- Department of Orthopedics, Pediatric Orthopedics and Traumatology, Centre of Postgraduate Medical Education, Professor Adam Gruca Orthopedic and Trauma Teaching Hospital, Konarskiego 13, 05-400 Otwock, Poland; (T.P.); (J.C.)
- Correspondence: ; Tel.: +48-(22)-788-91-97
| | - Dariusz Grzelecki
- Department of Orthopedics and Rheumoorthopedics, Centre of Postgraduate Medical Education, Professor Adam Gruca Orthopedic and Trauma Teaching Hospital, Konarskiego 13, 05-400 Otwock, Poland;
| | - Tomasz Parol
- Department of Orthopedics, Pediatric Orthopedics and Traumatology, Centre of Postgraduate Medical Education, Professor Adam Gruca Orthopedic and Trauma Teaching Hospital, Konarskiego 13, 05-400 Otwock, Poland; (T.P.); (J.C.)
| | - Jarosław Czubak
- Department of Orthopedics, Pediatric Orthopedics and Traumatology, Centre of Postgraduate Medical Education, Professor Adam Gruca Orthopedic and Trauma Teaching Hospital, Konarskiego 13, 05-400 Otwock, Poland; (T.P.); (J.C.)
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Qi J, Thakrar PD, Browning MB, Vo N, Kumbhar SS. Clinical utilization of whole-body PET/MRI in childhood sarcoma. Pediatr Radiol 2021; 51:471-479. [PMID: 33040234 DOI: 10.1007/s00247-020-04834-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/12/2020] [Accepted: 08/27/2020] [Indexed: 01/10/2023]
Abstract
Hybrid positron emission tomography (PET)/magnetic resonance imaging (MRI) has emerged as a useful tool that combines the superior tissue contrast of MRI with the targeted functional imaging of PET. In the assessment of sarcomas in children, PET/MRI has the potential to serve as a single point of service, allowing superior anatomical imaging and evaluation of metabolic uptake during one imaging session. In this pictorial essay, we review our preliminary experience with PET/MRI in the evaluation of pediatric sarcoma. The limitations and contraindications of PET/MRI are also discussed.
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Affiliation(s)
- Jing Qi
- Department of Radiology, Children's Wisconsin and the Medical College of Wisconsin, 9000 W. Wisconsin Ave., MS-721, Milwaukee, WI, 53226, USA.
| | - Pooja D Thakrar
- Department of Radiology, Children's Wisconsin and the Medical College of Wisconsin, 9000 W. Wisconsin Ave., MS-721, Milwaukee, WI, 53226, USA
| | - Meghen B Browning
- Department of Pediatric Hematology and Oncology, Children's Wisconsin and the Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nghia Vo
- Department of Radiology, Children's Wisconsin and the Medical College of Wisconsin, 9000 W. Wisconsin Ave., MS-721, Milwaukee, WI, 53226, USA
| | - Sachin S Kumbhar
- Department of Radiology, Children's Wisconsin and the Medical College of Wisconsin, 9000 W. Wisconsin Ave., MS-721, Milwaukee, WI, 53226, USA
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Iwatsuki K, Yoneda H, Onishi T, Ishii H, Kurimoto S, Yamamoto M, Tatebe M, Hirata H. Compatibility of magnetic resonance imaging in patients with orthopedic implants: manufacturer questionnaires. NAGOYA JOURNAL OF MEDICAL SCIENCE 2021; 82:79-84. [PMID: 32273635 PMCID: PMC7103874 DOI: 10.18999/nagjms.82.1.79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In clinical practice, surgeons have stated that magnetic resonance imaging (MRI) can be performed in patients with titanium alloy implants. However, manufacturers and distributors of many implants may not comply with this common practice. As such, this study aimed to investigate manufacturers’ views on MRI use in patients fitted with their implants. The questionnaire survey was conducted between May and August 2018. Is your product compatible with MRI? ( ) Select from (1) to (3). In case of (1) or (2), up to ( ) Tesla. (1) MRI can be performed even at the sites of implanted fixators. (2) MRI can be performed at sites without implanted fixators. (3) MRI cannot be performed, or the manufacturer does not approve MRI use (cannot issue a certificate). The questionnaire forms were sent to 12 manufacturers, and the response rate was 100%. Manufacturers responded that they could not publicly allow MRI use in patients with their products. These findings do not conclude that MRI cannot be performed in such patients. This survey revealed that currently decisions regarding MRI use is left to the treating physicians. This situation poses a great problem for medical safety and imposes a substantial burden on physicians. As many problems remain in the field of orthopedic surgery, manufacturers of implants should proactively manage issues surrounding the usage of MRI.
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Affiliation(s)
- Katsuyuki Iwatsuki
- Department of Hand surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hidemasa Yoneda
- Department of Hand surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tetsuro Onishi
- Department of Hand surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hisao Ishii
- Department of Hand surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shigeru Kurimoto
- Department of Hand surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Michiro Yamamoto
- Department of Hand surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiro Tatebe
- Department of Hand surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hitoshi Hirata
- Department of Hand surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Eltayeby HH, Alrabai HM, Jauregui JJ, Shabtai LY, Herzenberg JE. Post-retrieval functionality testing of PRECICE lengthening nails: The "Sleeper" nail concept. J Clin Orthop Trauma 2020; 14:151-155. [PMID: 33717907 PMCID: PMC7920018 DOI: 10.1016/j.jcot.2020.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 04/14/2020] [Accepted: 06/04/2020] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION PRECICE intramedullary magnetic lengthening nails, introduced in 2011, have changed the landscape of long bone limb lengthening. The implants have a stroke ranging from 5 to 8 cm, but it may be desirable to perform part of the lengthening at one treatment, allow bone healing, leave the implant in place, dormant, and then return one or more years later to re-lengthen with the same implant. We call this the "sleeper" nail concept. This strategy may be gentler for the joints and soft tissues. Would the nail mechanism still be functional one or more years later? METHODS We tested 102 intact, consecutively explanted nails. Using a "fast magnet," the male part was lengthened to 5 mm short of its maximum stroke capacity and retracted back to 35 mm (all nails start with the male part exposed 30 mm). The nails passed the test if the male part succeeded in lengthening to 5 mm short of the maximum stroke capacity and back to 35 mm (or only retract in case fully deployed at testing). During our testing, the nails were prevented from reaching their full capacity of lengthening/retraction to avoid jamming the gears. Failure was defined as the inability or partial ability to complete the process. RESULTS Eighty-six nails (84.3%) performed successfully according to our testing standard. When comparing successful and failed nails in terms of nail type, generation, diameter, length and in vivo interval, there was no statistical significance. Comparing both groups in terms of status at testing (fully deployed or not) showed statistical significance with 9 of the 16 failed nails fully deployed at testing (p < 0.001). CONCLUSION Dormant PRECICE nails can be reactivated for further lengthening. The results imply that full deployment may damage the mechanism, making future re-use by retracting and then re-lengthening unsuccessful. The candidate nails for this purpose should not have any signs of clear damage (bending or breakage) and should not have been fully deployed. However, surgeons and patients should be aware of the need for possible nail exchange if the "sleeper" nail fails to wake up. LEVEL OF EVIDENCE Level IV case series analysis of retrieved surgical implants.
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Affiliation(s)
- Hady H. Eltayeby
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD, USA,Department of Orthopedics, Alexandria University, Alexandria, Egypt
| | - Hamza M. Alrabai
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD, USA,Department of Orthopedics, King Saud University, Riyadh, Saudi Arabia
| | - Julio J. Jauregui
- Department of Orthopaedics, University of Maryland Medical Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - John E. Herzenberg
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD, USA,Corresponding author. Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA.
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Barakat AH, Sayani J, O'Dowd-Booth C, Guryel E. Lengthening Nails for Distraction Osteogenesis: A Review of Current Practice and Presentation of Extended Indications. Strategies Trauma Limb Reconstr 2020; 15:54-61. [PMID: 33363643 PMCID: PMC7744668 DOI: 10.5005/jp-journals-10080-1451] [Citation(s) in RCA: 8] [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: 12/12/2022] Open
Abstract
PURPOSE Circular frames have been the gold standard of treatment for complex deformity corrections and bone loss. However, despite the success of frames, patient satisfaction has been low, and complications are frequent. Most recently, lengthening nails have been used to correct leg length discrepancies. In this article, we review the current trends in deformity correction with emphasis on bone lengthening and present our case examples on the use of lengthening nails for management of complex malunions, non-unions, and a novel use in bone transport. MATERIALS AND METHODS A nonsystematic literature review on the topic was performed. Four case examples from our institute, Brighton and Sussex University Hospitals, East Sussex, England, UK, were included. RESULTS New techniques based on intramedullary bone lengthening and deformity correction are replacing the conventional external frames. Introduction of lengthening and then nailing and lengthening over a nail techniques paved the way for popularization of the more recent lengthening nails. Lengthening nails have gone through evolution from the first mechanical nails to motorized nails and more recently the magnetic lengthening nails. Two case examples demonstrate successful use of lengthening nails for management of malunion, and two case examples describe novel use in management of non-unions, including the first report in the literature of plate-assisted bone segment transport for the longest defect successfully treated using this novel technique. CONCLUSION With the significant advancement of intramedullary lengthening devices with lower complications rates and higher patient satisfaction, the era of the circular frame may be over. HOW TO CITE THIS ARTICLE Barakat AH, Sayani J, O'Dowd-Booth C, et al. Lengthening Nails for Distraction Osteogenesis: A Review of Current Practice and Presentation of Extended Indications. Strategies Trauma Limb Reconstr 2020;15(1):54-61.
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Affiliation(s)
- Ahmed H Barakat
- Department of Trauma and Orthopaedics, Brighton and Sussex University Hospitals, East Sussex, England, UK
| | - Junaid Sayani
- Department of Trauma and Orthopaedics, Maidstone and Tunbridge Wells NHS Trust, UK
| | - Christopher O'Dowd-Booth
- Department of Trauma and Orthopaedics, Brighton and Sussex University Hospitals, East Sussex, England, UK
| | - Enis Guryel
- Department of Trauma and Orthopaedics, Brighton and Sussex University Hospitals, East Sussex, England, UK
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