Strategies in Trauma and Limb Reconstruction

Register      Login

VOLUME 17 , ISSUE 3 ( September-December, 2022 ) > List of Articles

REVIEW ARTICLE

Humerus Lengthening with a Motorized Intramedullary Nail: A Systematic Review of Outcomes and Complications

Justin-Pierre Lorange, Nawaf Alamiri, Yousef Marwan, Abdullah Alshammari, Reggie Charles Hamdy, Mitchell Bernstein

Keywords : Clinical outcomes, Humerus, Limb lengthening, Motorized intramedullary nail, Systematic review

Citation Information : Lorange J, Alamiri N, Marwan Y, Alshammari A, Hamdy RC, Bernstein M. Humerus Lengthening with a Motorized Intramedullary Nail: A Systematic Review of Outcomes and Complications. 2022; 17 (3):165-171.

DOI: 10.5005/jp-journals-10080-1568

License: CC BY-NC-SA 4.0

Published Online: 30-12-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Aim: In the past decade, internal limb lengthening nails have gained popularity. In this study, we aim to systematically review the literature on humerus limb lengthening with a motorized intramedullary nail (MIN). We intend to assess the outcome and complications of this technique. Materials and methods: A systematic review was performed in the following databases: PubMed, Embase, Web of Science, and the Journal of Limb Lengthening and Reconstruction. The inclusion criteria included limb lengthening of the humerus using an intramedullary nail, clinical studies, all levels of evidence, and no restriction to the date of publication. Results: Our search yielded 239 journal articles. A total of nine articles remained relevant based on the inclusion and exclusion criteria. The total number of patients was 20, with 22 segments lengthened. The mean age of the patients was 20.8-year-old [standard deviation (SD), 12.0; range, 13–51]. The mean gained length was 5.7 cm (SD, 0.9; range, 5–7.5) with a mean distraction protocol of 0.82 mm/day (SD, 0.2; range, 0.6–1). The average duration of lengthening was 71.6 days (SD, 12.8; range, 50–93), and the mean duration of consolidation was 192.3 days (SD, 40.5; range, 120–228). Reported complications included a range of motion (ROM) limitation, hardware failure, and hypertrophic bone regeneration. Conclusion: Humeral lengthening with an MIN provides favourable outcomes with low complication rates. Future high-level studies should focus on comparing long-term outcomes of humeral lengthening utilising internal and external fixation techniques. Clinical significance: Humeral lengthening using MIN can be used safely. Each surgical approach and type of nail have different risks and benefits. These should be carefully discussed when planning the surgery.


PDF Share
  1. Lee FY, Schoeb JS, Yu J, et al. Operative lengthening of the humerus: Indications, benefits, and complications. J Pediatr Orthop 2005;25(5):613–616. DOI: 10.1097/01.bpo.0000164868.97060.bb.
  2. Cattaneo R, Catagni MA, Guerreschi F. Applications of the Ilizarov method in the humerus. Lengthenings and nonunions. Hand Clin 1993;9(4):729–739. PMID: 8300742.
  3. Gachons SPD, Pouliquen JC, Penneçot GF. Progressive lengthening of the upper limb in 2 patients. Rev Chir Orthop Reparatrice Appar Mot 1982;68(6):385–389. PMID: 6217522.
  4. Tetsworth K, Krome J, Paley D. Lengthening and deformity correction of the upper extremity by the Ilizarov technique. Orthop Clin North Am 1991;22(4):689–713. PMID: 1945346.
  5. Hosny GA. Unilateral humeral lengthening in children and adolescents. J Pediatr Orthop B 2005;14(6):439–443. DOI: 10.1097/01202412-200511000-00010.
  6. Al-Sayyad MJ. Taylor spatial frame in the treatment of upper extremity conditions. J Pediatr Orthop 2012;32(2):169–178. DOI: 10.1097/BPO.0b013e3182471ae4.
  7. Malot R, Park KW, Song SH, et al. Role of hybrid monolateral fixators in managing humeral length and deformity correction. Acta Orthop 2013;84(3):280–285. DOI: 10.3109/17453674.2013.786636.
  8. Pawar AY, McCoy TH Jr., Fragomen AT, et al. Does humeral lengthening with a monolateral frame improve function? Clin Orthop Relat Res 2013;471(1):277–283. DOI: 10.1007/s11999-012-2543-9.
  9. Yang CB, Huang SC. Humeral lengthening using the Ilizarov technique. J Formos Med Assoc 1997;96(4):291–294. PMID: 9136519.
  10. Hammouda AI, Standard SC, Robert Rozbruch S, et al. Humeral lengthening with the PRECICE magnetic lengthening nail. Hss j. 2017;13(3):217–223. DOI: 10.1007/s11420-017-9552-x.
  11. Kurtz AM, Rozbruch SR. Humerus lengthening with the PRECICE internal lengthening nail. J Pediatr Orthop 2017;37(4):e296–e300.
  12. Morrison SG, Georgiadis AG, Dahl MT. Lengthening of the humerus using a motorized lengthening nail: A retrospective comparative series. J Pediatr Orthop 2020;40(6):e479–e486. DOI: 10.1097/BPO.0000000000001453.
  13. Frost MW, Rahbek O, Traerup J, et al. Systematic review of com-plications with externally controlled motorized intramedullary bone lengthening nails (FITBONE and PRECICE) in 983 segments. Acta Orthopaedica 2021;92(1):120–127. DOI: 10.1080/17453674.2020.1835321.
  14. Green SA. The evolution of remote-controlled intramedullary lengthening and compression nails. J Orthopaed Trauma 2017;31(Suppl. 6):S2–S6. DOI: 10.1097/BOT.0000000000000844.
  15. Rozbruch SR, Birch JG, Dahl MT, et al. Motorized intramedullary nail for management of limb-length discrepancy and deformity. J Am Acad Orthop Surg 2014;22(7):403–409. DOI: 10.5435/JAAOS-22-07-403.
  16. Paley D. PRECICE intramedullary limb lengthening system. Expert Rev Med Devices 2015;12(3):231–249. DOI: 10.1586/17434440.2015.1005604.
  17. Betz A, Baumgart R, Schweiberer L. First fully implantable intramedullary system for callus distraction: Intramedullary nail with programmable drive for leg lengthening and segment displacement. Principles and initial clinical results. Chirurg 1990;61(8):605–609. PMID: 2226033.
  18. Cole JD, Justin D, Kasparis T, et al. The intramedullary skeletal kinetic distractor (ISKD): First clinical results of a new intramedullary nail for lengthening of the femur and tibia. Injury 2001;32(Suppl. 4):SD129– SD139. DOI: 10.1016/s0020-1383(01)00116-4.
  19. Guichet JM, Deromedis B, Donnan LT, et al. Gradual femoral lengthening with the Albizzia intramedullary nail. J Bone Joint Surg Am 2003;85(5):838–848. DOI: 10.2106/00004623-200305000-00011.
  20. Hankemeier S, Pape HC, Gosling T, et al. Improved comfort in lower limb lengthening with the intramedullary skeletal kinetic distractor. Principles and preliminary clinical experiences. Arch Orthop Trauma Surg 2004;124(2):129–133. DOI: 10.1007/s00402-003-0625-6.
  21. Kenawey M, Krettek C, Liodakis E, et al. Leg lengthening using intramedullay skeletal kinetic distractor: Results of 57 consecutive applications. Injury 2011;42(2):150–155. DOI: 10.1016/j.injury.2010.06.016.
  22. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021;372:n71. DOI: 10.1136/bmj.n71.
  23. Fürmetz J, Kold S, Schuster N, et al. Lengthening of the humerus with intramedullary lengthening nails: Preliminary report. Strategies Trauma Limb Reconstr 2017;12(2):99–106. DOI: 10.1007/s11751-017-0286-6.
  24. Euler SA, Hengg C, Kolp D, et al. 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 Joint J 2014;96-b(2):249–253. DOI: 10.1302/0301-620X.96B2.31293.
  25. Scheerlinck T, Handelberg F. Functional outcome after intramedullary nailing of humeral shaft fractures: Comparison between retrograde Marchetti–Vicenzi and unreamed AO antegrade nailing. J Trauma 2002;52(1):60–71. DOI: 10.1097/00005373-200201000-00012.
  26. Rommens PM, Kuechle R, Bord T, et al. Humeral nailing revisited. Injury 2008;39(12):1319–1328. DOI: 10.1016/j.injury.2008.01.014.
  27. Cattaneo R, Villa A, Catagni MA, et al. Lengthening of the humerus using the Ilizarov technique. Description of the method and report of 43 cases. Clin Orthop Relat Res 1990(250):117–124. PMID: 2293919.
  28. Kashiwagi N, Suzuki S, Seto Y, et al. Bilateral humeral lengthening in achondroplasia. Clin Orthop Relat Res 2001(391):251–257. DOI: 10.1097/00003086-200110000-00029.
  29. Galal S, Shin J, Principe P, et al. Humerus lengthening: A comparison of the internal lengthening nail to external fixation. HSS J 2021;17(2):207–212. DOI: 10.1177/1556331621996334.
  30. Agrawal HK, Singh B, Garg M, et al. Cosmetic arm lengthening with monorail fixator. Chinese J Traumatol 2015;18(3):170–174. DOI: 10.1016/j.cjtee.2015.10.001.
  31. Tellisi N, Ilizarov S, Fragomen AT, et al. Humeral lengthening and deformity correction in Ollier’s disease: Distraction osteogenesis with a multiaxial correction frame. J Pediatr Orthop B 2008;17(3):152–157. DOI: 10.1097/BPB.0b013e3282f548dc.
  32. Zak L, Tiefenboeck TM, Wozasek GE. Innovative technique in extended intramedullary humeral lengthening: A case report. JBJS Case Connect 2019;9(3):e0174. DOI: 10.2106/JBJS.CC.18.00174.
  33. Jauregui JJ, Bor N, Thakral R, et al. Life- and limb-threatening infections following the use of an external fixator. Bone Joint J 2015;97-b(9):1296–1300. DOI: 10.1302/0301-620X.97B9.35626.
  34. Acan AE, Basci O, Havitcioglu H. Aneurysmal bone cyst healing response with intramedullary lengthening nail. Acta Orthop Traumatol Turc 2018;52(3):232–235. DOI: 10.1016/j.aott.2017.04.005
  35. Ghafoor H, Krieg A, Gehmert S. First humerus lengthening osteotomy with a magnet-operated intramedullary nail in Switzerland: A preliminary case report (9944). Swiss Medical Weekly. 2021;151(Suppl. 250):57S. https:// doi.org/10.4414/smw.2021.20563.
  36. Hoel R, Novotny S, Dahl M. Humeral lengthening using a retrograde motorized intramedullary lengthening nail. J Limb Lengthen Reconstr 2018;4(1):55–58. DOI: 10.4103/jllr.jllr_28_17.
  37. Tiefenboeck TM, Zak L, Wozasek GE. Intramedullary magnetically actuated limb lengthening in a patient with congenital humeral limb shortening. Injury 2016;47(7):1597–1600. DOI: 10.1016/j.injury.2016.04.019.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.