Strategies in Trauma and Limb Reconstruction

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VOLUME 16 , ISSUE 2 ( May-August, 2021 ) > List of Articles

Original Article

Complications in Elective Removal of 271 Bone Lengthening Nails (FITBONE, PRECICE and STRYDE)

Markus W Frost, Søren Kold, Ole Rahbek, Molly Duncan

Keywords : Bone lengthening, Bone lengthening nails, Bone nails, FITBONE, Intraoperative complications, Postoperative complications, PRECICE, STRYDE

Citation Information : Frost MW, Kold S, Rahbek O, Duncan M. Complications in Elective Removal of 271 Bone Lengthening Nails (FITBONE, PRECICE and STRYDE). 2021; 16 (2):110-115.

DOI: 10.5005/jp-journals-10080-1529

License: CC BY-NC-SA 4.0

Published Online: 27-10-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Background: Intramedullary lengthening nails have shown excellent short-term results. The FITBONE and the PRECICE nail are the two most commonly used intramedullary lengthening nails. The manufacturer of each nail recommends the removal of the implant after the completion of the treatment. Despite the need for removal of each nail, the authors are not aware of any prior publications documenting the results of standard intramedullary lengthening nail removal. Therefore, the aim of this study was to examine the intraoperative and postoperative complications of elective intramedullary lengthening nail removals. Materials and methods: We performed a retrospective chart review of patients operated with intramedullary lengthening nails at two limb reconstruction centres (one in the United States, and the second in Denmark). Data retrieved from the patient charts included patient demographics, nail information and any complications occurring at or after nail removal. Only lower limb lengthening with FITBONE and PRECICE or STRYDE nails that had an elective nail removal was included. Result: A total of 271 elective nail removals were included in the study. Complications occurred during 3% of the nail removals and in 13% after nail removal. There were 18 reported cases with postoperative knee pain. All these patients had nail removal through the knee joint, representing 8% of the retrograde femur nail removals and 7% of the tibia nail removals. Four postoperative fractures occurred, of which two needed surgery. Eleven percent of femur removals and 26% of tibial removals sustained a complication. Conclusion and clinical significance: This study emphasises the importance of adequate follow-up of the bone lengthening patient even after the nail has been removed. It also shows that the recommended removal of the intramedullary nail (IMN) lengthening nails must be included in studies reporting on the overall risks of complications using bone lengthening nails.

  1. Ilizarov GA. Clinical application of the tension-stress effect for limb lengthening. Clin Orthop Relat Res 1990;(250):8–26. PMID: 2403497.
  2. Paley D. Current techniques of limb lengthening. J Pediatr Orthop 1988;8(1):73–92. DOI: 10.1097/01241398-198801000-00018.
  3. De Bastiani G, Aldegheri R, Renzi-Brivio L, et al. Limb lengthening by callus distraction (callotasis). J Pediatr Orthop 1987;7(2):129–134. DOI: 10.1097/01241398-198703000-00002.
  4. Baumgart R, Betz A, Schweiberer L. A fully implantable motorized intramedullary nail for limb lengthening and bone transport. Clin Orthop Relat Res 1997;343:135–143. PMID: 9345218.
  5. Kirane YM, Fragomen AT, Rozbruch SR. Precision of the PRECICE internal bone lengthening nail. Clin Orthop Relat Res 2014;472(12):3869–3878. DOI: 10.1007/s11999-014-3575-0.
  6. Shabtai L, Specht SC, Standard SC, et al. Internal lengthening device for congenital femoral deficiency and fibular hemimelia. Clin Orthop Relat Res 2014;472(12):3860–3868. DOI: 10.1007/s11999-014-3572-3.
  7. Paley D, Harris M, Debiparshad K, et al. Limb lengthening by implantable limb lengthening devices. Tech Orthop 2014;29(2):72–85. DOI: 10.1097/BTO.0000000000000072.
  8. Horn J, Hvid I, Huhnstock S, et al. Limb lengthening and deformity correction with externally controlled motorized intramedullary nails: evaluation of 50 consecutive lengthenings. Acta Orthop 2019;90(1):81–87. DOI: 10.1080/17453674.2018.1534321.
  9. Iliadis AD, Palloni V, Wright J, et al. Pediatric lower limb lengthening using the PRECICE nail: our experience with 50 cases. J Pediatr Orthop 2021;41(1):e44–e49. DOI: 10.1097/BPO.0000000000001672.
  10. Frost MW, Rahbek O, Traerup J, et al. Systematic review of complications with externally controlled motorized intramedullary bone lengthening nails (FITBONE and PRECICE) in 983 segments. Acta Orthop 2021;92(1):120–127. DOI: 10.1080/17453674.2020.1835321.
  11. WITTENSTEIN intens. Nail manual: FITBONE® TAA surgical technique for tibia/femur. Doc-nr. 6091-D001185. Igersheim/Germany; 2009. 1–25 p.
  12. NuVasive, Standard SC, Herzenberg JE, et al. Nail manual: antegrade and retrograde femur operative technique. 16-NUVA-0740. San Diego, CA, USA; 1–38 p.
  13. NuVasive, Standard SC, Herzenberg JE, et al. Nail manual: antegrade tibia operative technique. 16-NUVA-0766. San Diego, CA 92121, USA; 1–30 p.
  14. NuVasive Specialized Orthopedics, Dror P, Standard SC, et al. Nail manual: precice stryde antegrade femur operative technique. Aliso Viejo, CA USA; 2019. 1–31 p.
  15. Noonan KJ, Leyes M, Forriol F, et al. Distraction osteogenesis of the lower extremity with use of monolateral external fixation: a study of two hundred and sixty-one femora and tibiae. J Bone Jt Surg – Ser A 1998;80(6):793–806. DOI: 10.2106/00004623-199806000-00003.
  16. Simpson AHRW, Kenwright J. Fracture after distraction osteogenesis. J Bone Jt Surg – Ser B 2000;82(5):659–665. DOI: 10.1302/0301-620x.82b5.9945.
  17. Leopold SS. A Conversation with … Nigel Packham PhD, NASA safety expert who analyzed the Space Shuttle Columbia disaster. Clin Orthop Relat Res 2021;479(2):215–220. DOI: 10.1097/CORR.0000000000001408.
  18. Stenroos A, Brinck T, Handolin L. Recommendation of use of checklists in tibial intramedullary nail removal: retrospective study of mechanical complications related to nail removal. Injury 2018;49(7):1341–1347. DOI: 10.1016/j.injury.2018.05.005.
  19. Zhang S, Wu X, Liu L, et al. Removal of interlocking intramedullary nail for relieve of knee pain after tibial fracture repair: a prospective study. J Orthop Surg 2017;25(1):1–5. DOI: 10.1177/2309499016684748.
  20. Seyhan M, Guler O, Mahirogullari M, et al. Complications during removal of stainless steel versus titanium nails used for intramedullary nailing of diaphyseal fractures of the tibia. Ann Med Surg 2018;26(Dec 2017):38–42. DOI: 10.1016/j.amsu.2017.12.012.
  21. Robbins C, Paley D. Stryde weight-bearing internal lengthening nail. Tech Orthop 2020;35(3):201–208. DOI: 10.1097/BTO.0000000000000475.
  22. Martin RCG, Brennan MF, Jaques DP. Quality of complication reporting in the surgical literature. Ann Surg 2002;235(6):803–813. DOI: 10.1097/00000658-200206000-00007.
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