Strategies in Trauma and Limb Reconstruction

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VOLUME 12 , ISSUE 2 ( August, 2017 ) > List of Articles

Original Article

Lengthening of the humerus with intramedullary lengthening nails—preliminary report

Søren Kold, Nikola Schuster, Peter H. Thaller

Keywords : Humerus lengthening, Intramedullary lengthening, Distraction osteogenesis, Lengthening nail, FITBONE, PRECICE

Citation Information : Kold S, Schuster N, Thaller PH. Lengthening of the humerus with intramedullary lengthening nails—preliminary report. 2017; 12 (2):99-106.

DOI: 10.1007/s11751-017-0286-6

License: CC BY-NC-SA 4.0

Published Online: 01-06-2015

Copyright Statement:  Copyright © 2017; The Author(s).


Abstract

Distraction osteogenesis of the humerus with fully implantable lengthening is now possible since the diameter of the available nails was reduced to 10 mm and below. We report on the first intramedullary lengthening cases of the humerus with two different lengthening devices (FITBONE and PRECICE). Two different approaches and implantation techniques were used. We retrospectively reviewed clinical and radiographic data and pointed out results, pitfalls and complications of the procedure. Four adult patients with relevant length discrepancy of the humerus were treated with fully implantable systems in two centers between 2012 and 2015. Three patients were treated with FITBONE by an antegrade approach; one patient had lengthening with a PRECICE and a retrograde approach. Average nail lengthening was 55 mm (40–65 mm), and the average duration of lengthening was 70 days (52–95 days). The average distraction index was 0.72 mm/day (range 0.4–1.0 mm/day) or 12.5 days/cm (range 8.0–16.2 days/cm). The average consolidation index was 33.6 days/cm (range 25–45 days/cm). There was an implant failure (arrest) with the PRECICE. After consolidation and exchange with a technically improved implant, the course of treatment was uneventful. In patients with antegrade lengthening shoulder abduction decreased, and in the patient with the retrograde approach it improved but elbow extension decreased marginally. Reduced motion of the adjacent joints can be a major problem in intramedullary lengthening of the humerus. This first case series in the field of a rare indication suggests that lengthening of the humerus by fully implantable lengthening nails might be a valuable alternative to lengthening with external fixation. Main advantage of the PRECICE technology is the possible shortening in-between of lengthening.


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  1. Ilizarov GA (1990) Clinical application of the tension-stress effect for limb lengthening. Clin Orthop Relat Res 250:8-26
  2. Tetsworth K, Krome J, Paley D (1991) Lengthening and deformity correction of the upper extremity by the Ilizarov technique. Orthop Clin North Am 22:689-713
  3. Dick HM, Tietjen R (1978) Humeral lengthening for septic neonatal growth arrest. Case report. J Bone Jt Surg Am 60:1138-1139
  4. Cattaneo R, Villa A, Catagni MA, Bell D (1990) Lengthening of the humerus using the Ilizarov technique. Description of the method and report of 43 cases. Clin Orthop Relat Res 250:117-124
  5. Hosny GA (2005) Unilateral humeral lengthening in children and adolescents. J Pediatr Orthop Part B 14:439-443
  6. Kashiwagi N, Suzuki S, Seto Y, Futami T (2001) Bilateral humeral lengthening in achondroplasia. Clin Orthop Relat Res 391:251-257
  7. McCarthy JJ, Ranade A, Davidson RS (2008) Pediatric deformity correction using a multiaxial correction fixator. Clin Orthop Relat Res 466:3011-3017
  8. Pawar AY, McCoy TH, Fragomen AT, Rozbruch SR (2013) Does humeral lengthening with a monolateral frame improve function? Clin Orthop Relat Res 471:277-283
  9. Balci HI, Kocaoglu M, Sen C, Eralp L, Batibay SG, Bilsel K (2015) Bilateral humeral lengthening in achondroplasia with unilateral external fixators: is it safe and does it improve daily life? Bone Jt J 97-B:1577-1581
  10. Paley D (2015) PRECICE intramedullary limb lengthening system. Expert Rev Med Devices 12:231-249
  11. Betz A, Baumgart R, Schweiberer L (1990) First fully implantable intramedullary system for callus distraction-intramedullary nail with programmable drive for leg lengthening and segment displacement. Principles and initial clinical results. Chir Z Für Alle Geb Oper Med 61:605-609
  12. Cole JD, Justin D, Kasparis T, DeVlught D, Knobloch C (2001) The intramedullary skeletal kinetic distractor (ISKD): first clinical results of a new intramedullary nail for lengthening of the femur and tibia. Injury 32(Suppl 4):SD129-SD139
  13. Hankemeier S, Pape H-C, Gosling T, Hufner T, Richter M, Krettek C (2004) Improved comfort in lower limb lengthening with the intramedullary skeletal kinetic distractor. Principles and preliminary clinical experiences. Arch Orthop Trauma Surg 124:129-133
  14. Guichet J-M, Deromedis B, Donnan LT, Peretti G, Lascombes P, Bado F (2003) Gradual femoral lengthening with the Albizzia intramedullary nail. J Bone Jt Surg Am 85-A:838-848
  15. Kenawey M, Krettek C, Liodakis E, Wiebking U, Hankemeier S (2011) Leg lengthening using intramedullary skeletal kinetic distractor: results of 57 consecutive applications. Injury 42:150-155
  16. Thaller PH, Zoffl F, Delhey P (2010) Comparison between fully implantable monitorized and mechanical distraction nails—a matched-pairs analysis. In 3rd world congress on external fixation and 6th congress of the ASAMI international presented at: podium session 37: bone reconstruction 6, Barcelona
  17. Thaller PH, Fürmetz J, Wolf F, Eilers T, Mutschler W (2014) Limb lengthening with fully implantable magnetically actuated mechanical nails (PHENIX(®))-preliminary results. Injury 45(Suppl 1):S60-S65
  18. Rozbruch S, Hamdy R. Limb lengthening and reconstruction surgery case Atlas [internet]. http://www.springer.com/cn/book/9783319036380
  19. Krieg AH, Lenze U, Speth BM, Hasler CC (2011) Intramedullary leg lengthening with a motorized nail. Acta Orthop 82:344-350
  20. Makhdom AM, Cartaleanu AS, Rendon JS, Villemure I, Hamdy RC (2015) The accordion maneuver: a noninvasive strategy for absent or delayed callus formation in cases of limb lengthening. Adv Orthop 2015:912790
  21. Euler SA, Hengg C, Kolp D, Wambacher M, Kralinger F (2014) Lack of fifth anchoring point and violation of the insertion of the rotator cuff during antegrade humeral nailing pitfalls in straight antegrade humeral nailing. Bone Jt J 96-B:249-253
  22. Scheerlinck T, Handelberg F (2002) Functional outcome after intramedullary nailing of humeral shaft fractures: comparison between retrograde Marchetti-Vicenzi and unreamed AO antegrade nailing. J Trauma 52:60-71
  23. Rommens PM, Kuechle R, Bord T, Lewens T, Engelmann R, Blum J (2008) Humeral nailing revisited. Injury 39:1319-1328. doi:10.1016/j.injury.2008.01.014
  24. Jauregui JJ, Bor N, Thakral R, Standard SC, Paley D, Herzenberg JE (2015) Life- and limb-threatening infections following the use of an external fixator. Bone Jt J 97-B:1296-1300
  25. Kirane YM, Fragomen AT, Rozbruch SR (2014) Precision of the PRECICE internal bone lengthening nail. Clin Orthop Relat Res 472:3869-3878
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