1
|
Olesen UK, Herzenberg JE, Hindsø K, Singh UM, Petersen MM. Plate-assisted bone-segment transport in the femur with 2 internal lengthening nails: a technical note and a case report. Acta Orthop 2023; 94:466-470. [PMID: 37712251 PMCID: PMC10506739 DOI: 10.2340/17453674.2023.18493] [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: 08/20/2022] [Accepted: 08/07/2023] [Indexed: 09/16/2023] Open
Abstract
A novel technique to resolve large bone defects, using 2 internal lengthening nails (ILNs), one antegrade and one retro-grade, aligned in a custom-made tube is presented. A 28-year-old, healthy, asymptomatic male presented with a slowly growing mass in the left femur.
Collapse
Affiliation(s)
- Ulrik Kähler Olesen
- Department of Orthopedic Surgery, Limb Reconstruction, Rigshospitalet, Copenhagen, Denmark.
| | | | - Klaus Hindsø
- Department of Orthopedic Surgery, Limb Reconstruction, Rigshospitalet, Copenhagen, Denmark
| | - Upender Martin Singh
- Department of Orthopedic Surgery, Limb Reconstruction, Rigshospitalet, Copenhagen, Denmark
| | - Michael Mørk Petersen
- Department of Orthopedic Surgery, Limb Reconstruction, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
2
|
Blair JA, Puneky GA, Swaminathan N, Klahs KJ, Davis JM. Tibial Bone Transport With a Single Implant All-Internal Bone Transport Nail. J Orthop Trauma 2023; 37:e294-e300. [PMID: 36730795 DOI: 10.1097/bot.0000000000002513] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 02/04/2023]
Abstract
SUMMARY A single implant all-internal magnet-driven bone transport nail (BTN-NuVasive Specialized Orthopaedics Inc) has recently been introduced as a treatment method for segmental tibial bone defects. This innovation provides promise in the management of segmental bone defects because it negates numerous complications associated with circular external fixation and the need for multiple implants when considering hybrid plate-assisted bone segment transport constructs. Given the novelty of the BTN, description of the surgical application and patient outcome measures are scarce in the current literature. To date, we have treated 4 patients with an average age of 27 years (range 19-44 years) using the BTN for segmental tibial defects ranging from 50 to 128 mm. We have accumulated data over an average follow-up of 18.07 months (range 12.96-25.13 months), demonstrating good patient tolerance of the device. Three patients successfully completed their treatment course with a calculated average bone healing index of 41.4 days/cm (range 31.41-54.82 days/cm). One patient was noted to experience an asymptomatic docking site nonunion requiring subsequent surgery for nonunion repair. Implant-associated complications included symptomatic implant, axial malalignment, docking site nonunion, and external remote control technical malfunction. Injury-related complications were encountered and noted to include: superficial infection, wound dehiscence, peroneal tendonitis, and joint rigidity. In this study, the authors present a case series using this implant to date and discuss our experiences with the BTN with reference to clinical indications, tibial bone preparation, BTN implantation, transport protocol, docking site procedure, and clinical/radiographic outcomes.
Collapse
Affiliation(s)
- James A Blair
- Department of Orthopedic Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia; and Medical Student, Medical College of Georgia at Augusta University, Augusta, Georgia; and Texas Tech University Health Sciences Center, El Paso, TX
| | | | | | | | | |
Collapse
|
3
|
Farhan-Alanie MM, Ward J, Kelly MB, Al-Hourani K. Current Perspectives on the Management of Bone Fragments in Open Tibial Fractures: New Developments and Future Directions. Orthop Res Rev 2022; 14:275-286. [PMID: 35983563 PMCID: PMC9380731 DOI: 10.2147/orr.s340534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/02/2022] [Indexed: 11/27/2022] Open
Abstract
Open tibial fractures may be associated with bone loss at the time of the injury or following surgical debridement of the fracture. This article discusses the various treatment options available and the latest developments surrounding the management of free bone fragments in open tibial fractures.
Collapse
Affiliation(s)
- Muhamed M Farhan-Alanie
- Department of Trauma & Orthopaedics, University Hospital Coventry & Warwickshire, Coventry, UK
- Correspondence: Muhamed M Farhan-Alanie, Email
| | - Jayne Ward
- Department of Trauma & Orthopaedics, University Hospital Coventry & Warwickshire, Coventry, UK
| | - Michael B Kelly
- Department of Trauma & Orthopaedics, Southmead Hospital, Bristol, UK
| | - Khalid Al-Hourani
- Department of Trauma & Orthopaedics, Royal Infirmary of Edinburgh, UK
| |
Collapse
|
4
|
Zuckerman LM, Scolaro JA, Gardner MP, Kern T, Lanz P, Quinnan SM, Watson JT, Rölfing JD. Technical considerations for the management of segmental osseous defects with an internal bone transport nail. Expert Rev Med Devices 2022; 19:203-211. [PMID: 35289241 DOI: 10.1080/17434440.2022.2054336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Traditionally, distraction osteogenesis has been accomplished with an external fixator. All internal transport utilizing magnetic intramedullary nails is a newer technique for bone reconstruction. The Precice Bone Transport Nail is a new implant that allows for noninvasive transport via a magnetically driven motor. AREAS COVERED This report describes the function of the Bone Transport Nail along with the technical considerations on how to successfully manage bone defects with this new technology. Appropriate use of the nail, preoperative planning, intraoperative considerations, and postoperative management are discussed in detail. EXPERT OPINION The Precice Bone Transport Nail utilizes the technology of the original Precice nail to provide an all-internal option for reconstruction of intercalary defects. This obviates the need for an additional plate with a standard Precice nail when performing bone transport and allows for a less invasive option that decreases operating room time. It provides a more cosmetic result than external fixation and avoids the risks of pin tract infection. Preoperative planning is essential to appropriate execution of the operative procedure and to perform a successful transport. A thorough understanding of the nail design and limitations are a prerequisite as this implant is significantly different from a standard intramedullary nail.
Collapse
Affiliation(s)
- Lee M Zuckerman
- Division of Orthopaedic Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - John A Scolaro
- Department of Orthopaedic Surgery, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Matthew P Gardner
- Department of Orthopaedic Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Thomas Kern
- Department of Orthopaedic Surgery, BG Hospital Murnau, Murnau am Staffelsee, Germany
| | - Philipp Lanz
- Departments of Orthopaedic Surgery, Medical University of Graz, Graz, Austria
| | - Stephen M Quinnan
- The Paley Orthopedic and Spine Institute, St. Mary's Medical Center, West Palm Beach, FL, USA
| | - J Tracy Watson
- Department of Orthopaedic Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA
| | | |
Collapse
|
5
|
Rölfing JD, Kold S, Nygaard T, Mikuzis M, Brix M, Faergemann C, Gottliebsen M, Davidsen M, Petruskevicius J, Olesen UK. Pain, osteolysis, and periosteal reaction are associated with the STRYDE limb lengthening nail: a nationwide cross-sectional study. Acta Orthop 2021; 92:479-484. [PMID: 33757381 PMCID: PMC8428270 DOI: 10.1080/17453674.2021.1903278] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Observing serious adverse events during treatment with the Precice Stryde bone lengthening nail (NuVasive, San Diego, CA, USA), we conducted a nationwide cross-sectional study to report the prevalence of adverse events from all 30 bone segments in 27 patients treated in Denmark.Patients and methods - Radiographs of all bone segments were evaluated regarding radiographic changes in February 2021. We determined the number of bone segments with late onset of pain and/or radiographically confirmed osteolysis, periosteal reaction, or cortical hypertrophy in the junctional area of the nail.Results - In 30 bone segments of 27 patients we observed radiographic changes in 21/30 segments of 20/27 patients, i.e., 19/30 osteolysis, 12/30 periosteal reaction (most often multi-layered), and 12/30 cortical hypertrophy in the area of the junction between the telescoping nail parts. Late onset of pain was a prominent feature in 8 patients. This is likely to be a prodrome to the bony changes. Discoloration (potential corrosion) at the nail interface was observed in multiple removed nails. 15/30 nails were still at risk of developing complications, i.e., were not yet removed.Interpretation - All Stryde nails should be monitored at regular intervals until removal. Onset of pain at late stages of limb lengthening, i.e., consolidation of the regenerate, should warrant immediate radiographic examination regarding osteolysis, periosteal reaction, and cortical hypertrophy, which may be associated with discoloration (potential corrosion) of the nail. We recommend removal of Stryde implants as early as possible after consolidation of the regenerate.
Collapse
Affiliation(s)
- Jan Duedal Rölfing
- Orthopaedic Reconstruction and Children’s Orthopaedics, Aarhus University Hospital, Aarhus
- Department of Clinical Medicine, Aarhus University, Aarhus
| | - Søren Kold
- Department of Orthopaedics, Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg
| | - Tobias Nygaard
- Department of Orthopaedics, Limb Lengthening and Bone Reconstruction Unit, Rigshospitalet, Copenhagen
| | - Mindaugas Mikuzis
- Department of Orthopaedics, Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg
| | - Michael Brix
- Department of Orthopaedics, Odense University Hospital, Odense, Denmark
| | | | - Martin Gottliebsen
- Orthopaedic Reconstruction and Children’s Orthopaedics, Aarhus University Hospital, Aarhus
| | - Michael Davidsen
- Orthopaedic Reconstruction and Children’s Orthopaedics, Aarhus University Hospital, Aarhus
| | - Juozas Petruskevicius
- Orthopaedic Reconstruction and Children’s Orthopaedics, Aarhus University Hospital, Aarhus
| | - Ulrik Kähler Olesen
- Department of Orthopaedics, Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg
| |
Collapse
|
6
|
Fibula-Assisted Segment Transport (FAST) for Defect Reconstruction after Resection of Tibial Adamantinoma: Report of Two Treatments. Case Rep Orthop 2021; 2021:5563931. [PMID: 34007499 PMCID: PMC8110409 DOI: 10.1155/2021/5563931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/21/2021] [Indexed: 12/13/2022] Open
Abstract
Intramedullary limb lengthening via lengthening nails has been performed for more than three decades to overcome leg length inequalities. Plate-assisted bone segment transport (PABST) has recently been described for the reconstruction of segmental bone defects. We modified this procedure by using the ipsilateral fibula as a “biological plate” and report on its technical particularities and application in the reconstructive treatment of adamantinomas of the tibia in two patients. Both patients were successfully treated by wide resection and reconstruction of the tibial bone via bone segment transport through an expandable intramedullary nail using the remaining ipsilateral fibula to provide stabilization and guidance. This procedure was titled “fibula-assisted segment transport” (FAST). This is a new and promising technique that allows an entirely biological reconstruction of large bone defects of the tibia.
Collapse
|