Strategies in Trauma and Limb Reconstruction

Register      Login

VOLUME 16 , ISSUE 1 ( January-April, 2021 ) > List of Articles

Original Article

Does Retrograde Femoral Nailing through a Normal Physis Impair Growth? An Experimental Porcine Model

Ahmed A Abood, Ole Rahbek, Morten L Olesen, Bjørn B Christensen, Bjarne Møller-Madsen, Søren Kold

Keywords : Children, Intramedullary nail, Leg length discrepancy

Citation Information : 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. 2021; 16 (1):8-13.

DOI: 10.5005/jp-journals-10080-1515

License: CC BY-NC-SA 4.0

Published Online: 00-04-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

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. 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.


PDF Share
  1. Friend L, Widmann RF. Advances in management of limb length discrepancy and lower limb deformity. Curr Opin Pediatr 2008;20(1):46–51. Available from: https://insights.ovid.com/crossref?an=00008480-200802000-00008. DOI: 10.1097/MOP.0b013e3282f35eeb.
  2. Li W, Xu R, Huang J, et al. Treatment of rabbit growth plate injuries with oriented ECM scaffold and autologous BMSCs. Sci Rep 2017;7:44140. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28266598. DOI: 10.1038/srep44140.
  3. Liu XC, Fabry G, Molenaers G, et al. Kinematic and kinetic asymmetry in patients with leg-length discrepancy. J Pediatr Orthop 1998;18(2):187–189. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9531400.
  4. Wagner H. Operative lengthening of the femur. Clin Orthop Relat Res 1978;(136):125–142. Available from: http://www.ncbi.nlm.nih.gov/pubmed/729276.
  5. Ilizarov GA. The tension-stress effect on the genesis and growth of tissues. Part I. The influence of stability of fixation and soft-tissue preservation. Clin Orthop Relat Res 1989;(238):249–281. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2910611.
  6. Ilizarov GA. The tension-stress effect on the genesis and growth of tissues: Part II. The influence of the rate and frequency of distraction. Clin Orthop Relat Res 1989;(239):263–285. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2912628.
  7. Ilizarov GA. Clinical application of the tension-stress effect for limb lengthening. Clin Orthop Relat Res 1990;(250):8–26. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2403497.
  8. Burke NG, Cassar-Gheiti AJ, Tan J, et al. Regenerate bone fracture rate following femoral lengthening in paediatric patients. J Child Orthop 2017;11(3):210–215. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28828065. DOI: 10.1302/1863-2548.11.160216.
  9. Saran N, Hamdy RC. DEXA as a predictor of fixator removal in distraction osteogenesis. Clin Orthop Relat Res 2008;466(12):2955–2961. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18820988. DOI: 10.1007/s11999-008-0514-y.
  10. Danziger MB, Kumar A, DeWeese J. Fractures after femoral lengthening using the Ilizarov method. J Pediatr Orthop;15(2):220–223. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7745098.
  11. Calder PR, Laubscher M, Goodier WD. The role of the intramedullary implant in limb lengthening. Injury 2017;48 Suppl 1:S52–S58. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0020138317302565. DOI: 10.1016/j.injury.2017.04.028.
  12. Paley D. PRECICE intramedullary limb lengthening system. Expert Rev Med Devices 2015;12(3):231–249. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25692375. DOI: 10.1586/17434440.2015.1005604.
  13. Singh S, Lahiri A, Iqbal M. The results of limb lengthening by callus distraction using an extending intramedullary nail (Fitbone) in non-traumatic disorders. J Bone Joint Surg Br 2006;88(7):938–942. Available from: http://online.boneandjoint.org.uk/doi/10.1302/0301-620X.88B7.17618. DOI: 10.1302/0301-620X.88B7.17618.
  14. Chung R, Foster BK, Xian CJ. Preclinical studies on mesenchymal stem cell-based therapy for growth plate cartilage injury repair. Stem Cells Int 2011;2011:570125. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3144692&tool=pmcentrez&rendertype=abstract. DOI: 10.4061/2011/570125.
  15. Kawamoto K, Kim W-C, Tsuchida Y, et al. Incidence of physeal injuries in Japanese children. J Pediatr Orthop B 2006;15(2):126–130. Available from: https://insights.ovid.com/crossref?an=01202412-200603000-00010. DOI: 10.1097/01.bpb.0000191874.69258.0b.
  16. Mann DC, Rajmaira S. Distribution of physeal and nonphyseal fractures in 2,650 long-bone fractures in children aged 0–16 years. J Pediatr Orthop 1990;10(6):713–716. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2250054. DOI: 10.1097/01241398-199011000-00002.
  17. Hammouda AI, Jauregui JJ, Gesheff MG, et al. Trochanteric entry for femoral lengthening nails in children: is it safe? J Pediatr Orthop 2017;37(4):258–264. Available from: http://insights.ovid.com/crossref?an=01241398-201706000-00014. DOI: 10.1097/BPO.0000000000000636.
  18. Rozbruch SR. Adult posttraumatic reconstruction using a magnetic internal lengthening nail. J Orthop Trauma 2017;31(6 Suppl):S14–S19. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28486285. DOI: 10.1097/BOT.0000000000000843.
  19. Baumgart R. The reverse planning method for lengthening of the lower limb using a straight intramedullary nail with or without deformity correction. A new method. Oper Orthop Traumatol 2009;21(2):221–233. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19685230. DOI: 10.1007/s00064-009-1709-4.
  20. Knapik DM, Zirkle LG, Liu RW. Consequences following distal femoral growth plate violation in an ovine model with an intramedullary implant: a pilot study. J Pediatr Orthop 2018;38(10):e640–e645. Available from: http://www.ncbi.nlm.nih.gov/pubmed/30074588. DOI: 10.1097/BPO.0000000000001234.
  21. Swindle MM, Makin A, Herron AJ, et al. Swine as models in biomedical research and toxicology testing. Vet Pathol 2012;49(2):344–356. Available from: http://vet.sagepub.com. DOI: 10.1177/0300985811402846.
  22. Jawetz ST, Shah PH, Potter HG. Imaging of physeal injury: overuse. Sports Health 2015;7(2):142–153. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25984260. DOI: 10.1177/1941738114559380.
  23. Foldager CB, Nyengaard JR, Lind M, et al. A stereological method for the quantitative evaluation of cartilage repair tissue. Cartilage 2015;6(2):123–132. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26069715. DOI: 10.1177/1947603514560655.
  24. Janovsky M, Tataruch F, Ambuehl M, et al. A Zoletil®-Rompun® mixture as an alternative to the use of opioids for immobilization of feral red deer. J Wild Dis 2000;36(4):663–669. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11085427. DOI: 10.7589/0090-3558-36.4.663.
  25. Shiguetomi-Medina JM, Ramirez-Gl JL, Stødkilde-Jørgensen H, et al. Systematized water content calculation in cartilage using T1-mapping MR estimations: design and validation of a mathematical model. J Orthop Traumatol 2017;18(3):217–220. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27771808. DOI: 10.1007/s10195-016-0433-8.
  26. Gottliebsen M. Guided growth of long bones using the tension band plating technique. Aarhus University Hospital; 2012.
  27. Christensen BB, Foldager CB, Hansen OM, et al. A novel nano-structured porous polycaprolactone scaffold improves hyaline cartilage repair in a rabbit model compared to a collagen type I/III scaffold: in vitro and in vivo studies. Knee Surg Sports Traumatol Arthrosc 2012;20(6):1192–2204. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21971941. DOI: 10.1007/s00167-011-1692-9.
  28. Kilkenny C, Browne WJ, Cuthill IC, et al. Improving bioscience research reporting: the arrive guidelines for reporting animal research. PLoS Biol 2010;8(6):e1000412. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20613859. DOI: 10.1371/journal.pbio.1000412.
  29. Ecklund K, Jaramillo D. Patterns of premature physeal arrest: MR imaging of 111 children. AJR Am J Roentgenol 2002;178(4):967–972. Available from: http://www.ajronline.org/doi/10.2214/ajr.178.4.1780967. DOI: 10.2214/ajr.178.4.1780967.
  30. Wang DC, Deeney V, Roach JW, et al. Imaging of physeal bars in children. Pediatr Radiol 2015;45(9):1403–1412. Available from: http://link.springer.com/10.1007/s00247-015-3280-5.
  31. Abood AAH, Møller-Madsen B, Shiguetomi-Medina JM, et al. Autologous cartilage and fibrin sealant may be superior to conventional fat grafting in preventing physeal bone bridge formation—a pilot study in porcines. J Child Orthop 2020;14(5):459–465. DOI: 10.1302/1863-2548.14.200024.
  32. Mäkelä EA, Vainionpää S, Vihtonen K, et al. The effect of trauma to the lower femoral epiphyseal plate. An experimental study in rabbits. J Bone Joint Surg Br 1988;70(2):187–191. Available from: http://www.ncbi.nlm.nih.gov/pubmed/3346285. DOI: 10.1302/0301-620X.70B2.3346285.
  33. Sharma M, MacKenzie WG, Bowen JR. Severe tibial growth retardation in total fibular hemimelia after limb lengthening. J Pediatr Orthop 1996;16(4):438–444. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8784694.
  34. Sabharwal S, Paley D, Bhave A, et al. Growth patterns after lengthening of congenitally short lower limbs in young children. J Pediatr Orthop 2000;20(2):137–145. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10739271.
  35. Lee SH, Szöke G, Simpson H. Response of the physis to leg lengthening. J Pediatr Orthop B 2001;10(4):339–343. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11727380.
  36. Shapiro F. Longitudinal growth of the femur and tibia after diaphyseal lengthening. J Bone Joint Surg Am 1987;69(5):684–690. Available from: http://www.ncbi.nlm.nih.gov/pubmed/3597468
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.