Complications and risk factors of intramedullary bone lengthening nails: a retrospective multicenter cohort study of 314 FITBONE and PRECICE nails

Abstract

Background and purpose: Intramedullary bone-lengthening nails have become increasingly popular. The 2 most used and successful nails are the FITBONE and the PRECICE nails. Uniform reporting is lacking on complications of intramedullary bone-lengthening nails. The purpose was therefore to assess and categorize the complications of lower limb bone-lengthening nails and investigate risk factors.Patients and methods: We performed a retrospective review of patients operated on with intramedullary lengthening nails at 2 hospitals. We included only lower limb lengthening with FITBONE and PRECICE nails. Recorded patient data was patient demographics, nail information, and any complication. Complications were graded according to severity and origin classification. Complication risk factors were assessed with modified Poisson regression.Results: 314 segments in 257 patients were included. The FITBONE nail was predominantly used (75%), and most of the lengthenings were performed in the femur (80%). 53% of the patients had complications. 269 complications were identified in 175 segments (144 patients). Device-related complications were most frequent (0.3 complications/segment), followed by joint complications (0.2 complications/segment). An increased relative risk was found for complications in the tibia compared with the femur and for age groups above 30 years compared with the 10–19 years group. Conclusion: Complications with intramedullary bone lengthening nails were more frequent than has previously been reported, with 53% of patients sustaining a complication. Future studies need to document the complications meticulously so that the true risk can be established.

Osmotic pump with potential for bone lengthening distracts continuously in vitro and in vivo

“…No technical defect could be detected visually, but a jamming of the mechanical components at the beginning of the elongation seems likely without clear evidence. In 2023, Frost et al [ 15 ] found 32% device related complications per lengthening segment analyzing the Fitbone ® and Precice ® implants, 22 (per 314 segments) directly related to the distraction mechanism. Their device related complication rate is in line with the presented data of this study.…”

“…Nevertheless, the construction of an osmotic pump is much less complex than other lengthening mechanisms on the market (e.g. motorized or magnetic), the latter with a reported 32% device related complication rate [ 15 ]. Therefore, in comparison, the implant related failure rate should be less when distracting with the osmotic pump.…”

What’s New in Limb Lengthening and Deformity Correction

“…A retrospective review of 30 patients who had antegrade magnetic nail lengthening of the femur confirmed that earlier commencement of full weight-bearing accelerated consolidation of the regenerate bone during lengthening 43 . A multicenter study reviewed 314 lower-limb segments treated with internal lengthening nails to assess the complications associated with this surgical procedure 44 . The authors found a 53% complication rate and a higher risk of complications in the tibia compared with the femur as well as for >30-year-old age groups.…”

Epidemiology and risk factors for premature physeal closure in distal femur fractures

“…Our outcome is binary, which is easier to interpret in odds-ratio terms: the effect of an explanatory variable is multiplicative on the odds and thus leads to an odds ratio. However, it should be noted that relative risk has been used in similar study designs [19].…”

“…In multivariable analysis, dislocation exceeding 10 mm was a risk factor for PPC (OR 6.3, CI 1. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22].…”