Strategies in Trauma and Limb Reconstruction

Register      Login

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

CASE REPORT

Dual Magnetically Expandable Intramedullary Nails for Treatment of a Large Bony Defect in a Patient with Sarcoma: A Case Report

Jonathan Copp, Steven Magister, Joshua Napora, Patrick Getty, John Sontich

Keywords : Distraction osteogenesis, Limb lengthening

Citation Information : Copp J, Magister S, Napora J, Getty P, Sontich J. Dual Magnetically Expandable Intramedullary Nails for Treatment of a Large Bony Defect in a Patient with Sarcoma: A Case Report. 2022; 17 (3):189-194.

DOI: 10.5005/jp-journals-10080-1560

License: CC BY-NC-SA 4.0

Published Online: 30-12-2022

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


Abstract

Aim: To describe the surgical technique of performing an all-internal lengthening to address a large diaphyseal femur defect in the sarcoma patient. Background: Various strategies exist to address large intercalary bone defects with various biomechanical and biological implications. Case description: A 23-year-old female with high-grade osteosarcoma of her left femur underwent wide resection and an internal reconstruction of a 12.5-cm femoral defect using dual magnetic lengthening intramedullary nails resulting in restoration of leg lengths, and pre-resection function with minimal residual disability. Conclusion: Preoperative chemotherapy, wide resection and post-operative chemotherapy for osteosarcoma are the current standard of care. Resection often leads to large bone defects requiring complex reconstruction. Following intercalary bone resection, biological reconstruction is a consideration. An all-inside technique was developed in an effort to minimise complications of long-term external fixation for distraction osteogenesis, or extensile secondary grafting procedures for induced membrane strategy. Clinical significance: This previously unreported surgical technique allows for an all-internal lengthening of large diaphyseal bone defects. While specifically used in an oncologic post-resection setting, this technique is applicable to the broader limb reconstruction and lengthening practice and overcomes some inherent limitations to previously described techniques.


PDF Share
  1. Messerschmitt PJ, Garcia RM, Abdul–Karim FW, et al. Osteosarcoma. J Am Acad Orthop Surg 2009;17(8):515–527. DOI: 10.5435/00124635-200908000-00005.
  2. Grimer RJ, Taminiau AM, Cannon SR, et al. Surgical outcomes in osteosarcoma. J Bone Joint Surg Br 2002;84(3):395–400. DOI: 10.1302/0301-620x.84b3.12019.
  3. Ozaki T, Nakatsuka Y, Kunisada T, et al. High complication rate of reconstruction using Ilizarov bone transport method in patients with bone sarcomas. Arch Orthop Trauma Surg 1998;118(3):136–139. DOI: 10.1007/s004020050333.
  4. Dahl MT, Morrison SG, Georgiadis AG, et al. What’s new in limb lengthening and deformity correction. J Bone Joint Surg Am 2019;101(16):1435–1439. DOI: 10.2106/JBJS.19.00584.
  5. Napora JK, Weinberg DS, Eagle BA, et al. Hexapod stacked transport for tibial infected nonunions with bone loss: long-term functional outcomes. J Orthop Trauma 2018;32(1):e12–e18. DOI: 10.1097/BOT.0000000000001005.
  6. Bernstein M, Fragomen A, Rozbruch SR. Tibial bone transport over an intramedullary nail using cable and pulleys. JBJS Essent Surg Tech 2018;8(1):e9. DOI: 10.2106/JBJS.ST.17.00035.
  7. Ferchaud F, Rony L, Ducellier F, et al. Reconstruction of large diaphyseal bone defect by simplified bone transport over nail technique: a 7-case series. Orthop Traumatol Surg Res 2017;103(7):1131–1136. DOI: 10.1016/j.otsr.2017.05.016.
  8. Wen H, Yang H, Xu Y. Extreme bone lengthening by bone transport with a unifocal tibial corticotomy: a case report. BMC Musculoskelet Disord 2019;20(1):555. DOI: 10.1186/s12891-019-2927-z.
  9. Yang Z, Jin L, Tao H, et al. Reconstruction of large tibial bone defects following osteosarcoma resection using bone transport distraction: a report of two cases. Oncol Lett 2016;12(2):1445–1447. DOI: 10.3892/ol.2016.4777.
  10. Wang W, Yang J, Wang Y, et al. Bone transport using the Ilizarov method for osteosarcoma patients with tumor resection and neoadjuvant chemotherapy. J Bone Oncol 2019;16:100224. DOI: 10.1016/j.jbo.2019.100224.
  11. Song H-R, Oh C-W, Mattoo R, et al. Femoral lengthening over an intramedullary nail using the external fixator: risk of infection and knee problems in 22 patients with a follow-up of 2 years or more. Acta Orthop 2005;76(2):245–252. DOI: 10.1080/00016470510030652.
  12. Zlowodzki M, Prakash JS, Aggarwal NK. External fixation of complex femoral shaft fractures. Int Orthop 2007;31:409–413. DOI: 10.1007/s00264-006-0187-7.
  13. Zhang Q, Zhang W, Zhang Z, et al. Femoral nonunion with segmental bone defect treated by distraction osteogenesis with monolateral external fixation. J Orthop Surg Res 2017;12(1):183. DOI: 10.1186/s13018-017-0684-y.
  14. Barinaga G, Beason AM, Gardner MP. Novel surgical approach to segmental bone transport using a magnetic intramedullary limb lengthening system. J Am Acad Orthop Surg 2008;26(22):e477–e482. DOI: 10.5435/JAAOS-D-17-00487.
  15. Olesen UK, Nygaard T, Prince DE, et al. Plate-assisted bone segment transport with motorized lengthening nails and locking plates: a technique to treat femoral and tibial bone defects. J Am Acad Orthop Surg Glob Res Rev 2019;3(8):e064. DOI: 10.5435/JAAOSGlobal-D-19-00064.
  16. Wright J, Bates P, Heidari N, et al. All internal bone transport: use of a lengthening nail and double plating for management of femoral bone loss. Strategies Trauma Limb Reconstr 2019;14(2):94–101. DOI: 10.5005/jp-journals-10080-1431.
  17. Whelan JS, Bielack SS, Marina N, et al. EURAMOS-1, an international randomised study for osteosarcoma: results from pre-randomisation treatment. Ann Oncol 2005;26(2):407–414. DOI: 10.1093/annonc/mdu526.
  18. Misaghi A, Goldin A, Awad M, et al. Osteosarcoma: a comprehensive review. SICOT-J 2018;4:12. DOI: 10.1051/sicotj/2017028.
  19. Ruggieri P, Mavrogenis AF, Bianchi G, et al. Outcome of the intramedullary diaphyseal segmental defect fixation system for bone tumors. J Surg Oncol 2011;104(1):83–90. DOI: 10.1002/jso.21893.
  20. Zheng K, Yu X-C, Hu Y-C, et al. Outcome of segmental prosthesis reconstruction for diaphyseal bone tumors: a multi-center retrospective study. BMC Cancer 2019;19(1):638. DOI: 10.1186/s12885-019-5865-0.
  21. Paley D. Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop Relat Res 1990;250:81–104. DOI: 10.1097/00003086-199001000-00011.
  22. Mukhopadhaya J, Raj M. Distraction osteogenesis using combined locking plate and Ilizarov fixator in the treatment of bone defect: a report of 2 cases. Indian J Orthop 2017;51:222–228. DOI: 10.4103/0019-5413.201710.
  23. Horn J, Grimsrud Ø, Dagsgard AH, et al. Femoral lengthening with a motorized intramedullary nail. Acta Orthop 2015;86(2):248–256. DOI: 10.3109/17453674.2014.960647.
  24. Landge V, Shabtai L, Gesheff M, et al. Patient satisfaction after limb lengthening with internal and external devices. J Surg Orthop Adv 2015;24(3):174–179. PMID: 26688988.
  25. Rozbruch SR, Kleinman D, Fragomen AT, et al. Limb lengthening and then insertion of an intramedullary nail: a case-matched comparison. Clin Orthop Relat Res 2018;466(12):2923–2932. DOI: 10.1007/s11999-008-0509-8.
  26. Chen F, Wang Z, Bhattacharyya T. Outcomes of nails versus plates for humeral shaft fractures: a medicare cohort study. J Orthop Trauma 2013;27:68–72. DOI: 10.1097/BOT.0b013e31824a3e66.
  27. Saw A, Chua YP, Hossain G. Rates of pin site infection during distraction osteogenesis based on monthly observations: a pilot study. J Orthop Surg (Hong Kong) 2012;20(2):181–184. DOI: 10.1177/230949901202000209.
  28. Ceroni D, Grumetz C, Desvachez O, et al. From prevention of pin-tract infection to treatment of osteomyelitis during paediatric external fixation. J Child Orthop 2016;10(6):605–612. DOI: 10.1007/s11832-016-0787-8.
  29. Morelli I, Drago L, George DA, et al. Managing large bone defects in children: a systematic review of the “induced membrane technique”. J Pediatr Orthop B 2018;27(5):443–455. DOI: 10.1097/BPB.0000000000000456.
  30. Lee DH, Kim S, Lee JW, et al. A comparison of the device-related complications of intramedullary lengthening nails using a new classification system. Biomed Res Int 2017:2017:8032510. DOI: 10.1155/2017/8032510.
  31. Dvorzhinskiy A, Zhang DT, Fragomen AT, Rozbruch SR (2021) Cost comparison of tibial distraction osteogenesis using external lengthening and then nailing vs internal magnetic lengthening nails. Strategies Trauma Limb Reconstr 16(1):14–19. DOI: 10.5005/jp-journals-10080-1513.
  32. Davda K, Heidari N, Calder P, et al. “Rail and nail” bifocal management of atrophic femoral nonunion. Bone Joint J 2018;100-B(5):634–639. DOI: 10.1302/0301-620X.100B5.BJJ-2017-1052.R1.
  33. Gomez C, Nelson S, Speirs J, et al. Magnetic intramedullary lengthening nails and MRI compatibility. J Pediatr Orthop 2018;38(1):e584–e587. DOI: 10.1097/BPO.0000000000001236.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.