Motorized Intramedullary Nail for Management of Limb-length Discrepancy and Deformity

Rozbruch, S. Robert; Birch, John G.; Dahl, Mark T.; Herzenberg, John E.

doi:10.5435/jaaos-22-07-403

Cited by 110 publications

(69 citation statements)

References 19 publications

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“…The application of a magnet-operated, remote-controlled intramedullary (IM) lengthening nail continues to provide new opportunities for accurate limb equalization with excellent functional outcomes and improved consolidation indices [1], [2], [3], [4], [5], [6]. Bone lengthening with internal devices provides decreased complication rates compared with external fixation, including pin tract infections, soft-tissue tethering, and joint stiffness [1], [4], [5]. The PRECICE nail system (NuVasive Specialized Orthopedics, Aliso Viejo, CA) is an IM, magnetic, telescopic rod that is activated through an external handheld controller.…”

Section: Introductionmentioning

confidence: 99%

Total hip arthroplasty and femoral nail lengthening for hip dysplasia and limb-length discrepancy

et al. 2018

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The application of distraction osteogenesis through the use of magnet-operated, remote-controlled intramedullary lengthening continues to provide new opportunities for accurate limb equalization. While limb-length discrepancy and deformity can be addressed by total hip arthroplasty alone, the magnitude of correction is limited by the soft-tissue envelope and complications such as sciatic nerve palsy. This 3-patient case series presents the combination of staged ipsilateral total hip arthroplasty and retrograde intramedullary femoral nail lengthening for the correction of both deformity and limb-length discrepancy. Our results report leg-length equalization, independent ambulation without assistive devices, and excellent bone and functional outcomes without complications, demonstrating that this combined technique can be used to achieve targeted lengthening and deformity correction.

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Section: Introductionmentioning

confidence: 99%

Total hip arthroplasty and femoral nail lengthening for hip dysplasia and limb-length discrepancy

et al. 2018

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“…Nail type, entry and length is defined accordingly. Piriformis nail entry should be avoided in adolescents to preserve femoral head blood supply [3].…”

Section: Pre-operative Evaluationmentioning

confidence: 99%

“…On the other hand, prolonged retention aiming for more consolidation is often resisted by tolerability issues. This tendency to minimise fixator time and the subsequent loss of protection created strategies such as lengthening and then nailing (LATN) and lengthening over a nail (LON) [3]. In these hybrid procedures, pathogens may gain access to the deep IM cavity through pin tracks [4,5].…”

Section: Introductionmentioning

confidence: 99%

Use of internal lengthening nails in post-traumatic sequelae

Alrabai

Gesheff

Conway

2017

International Orthopaedics (SICOT)

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External fixators are a well-established modality for treating fractures with bone defects, leg-length discrepancy, malunion, nonunion and other post-traumatic consequences. However, use of internal lengthening rods has remarkably increased recently for post-traumatic conditions. The main advantage of internal lengthening rods is eliminating pin-site complications. Internal lengthening rods are also associated with less pain. Motorised internal lengthening rods show promising performance in post-traumatic cases. Rigorous pre-operative planning is paramount to reducing lengthening-related complications. Certain types of internal lengthening rods offer bidirectional movement capability. Nail mechanism malfunction is a possibility with all kinds of nails. Direct doctor supervision is required, especially in the initial stages while the nail is lengthening. Internal lengthening nails are not as stiff as regular nails, with intricate internal mechanisms that can be broken under inattentive weightbearing activities. Preliminary positive outcomes indicate the role of internal lengthening rods in treating posttraumatic problems of leg-length discrepancy, malunion and nonunion.

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“…There are now 22 AAOSrecognized orthopaedic specialty societies, including the LLRS. The field of limb deformity is undergoing rapid growth and is attracting increasing numbers of orthopaedic surgeons [8][9][10]14]. By quantifying and qualifying the growth and volume of the surgical and academic activity on our service, we have demonstrated the role and use of such a service within a larger parent orthopaedic department.…”

Section: Background and Rationalementioning

confidence: 98%

“…As a relatively new subspecialty, the field of limb deformity is growing in the breadth of surgical options for deformity correction [9,10]. For instance, recent, growing popularity of the motorized intramedullary nail requires a unique understanding of its uses and potential complications [8]. Despite increased awareness and practice of limb deformity surgery, it is rarely vested as a separate clinical service in an academic department of orthopaedic surgery.…”

Section: Introductionmentioning

confidence: 99%

What is the Utility Of a Limb Lengthening and Reconstruction Service in an Academic Department of Orthopaedic Surgery?

Rozbruch

Zonshayn

et al. 2015

Clin Orthop Relat Res

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Background Limb lengthening and reconstruction surgery is a relatively new subspecialty of orthopaedic surgery in the United States. Despite increased awareness and practice of the specialty, it is rarely vested as a separate clinical service in an academic department of orthopaedic surgery. We have had experience growing such a dedicated service within an academic department of orthopaedic surgery over the past 9 years. Questions/purposes We explored (1) the use of a limb deformity service (LDS) in an academic department of orthopaedic surgery by examining data on referral patterns, our clinical volume, and academic productivity; and (2) the surgical breadth of cases comprising the patients of the LDS in an academic department of orthopaedic surgery by examining data on caseload by anatomic sites, category, and surgical techniques/tools. Methods We (SRR, ATF, EWB) retrospectively examined data on numbers of surgical cases and outpatient visits from the limb lengthening and complex reconstruction service at the Hospital for Special Surgery from 2005 to 2013 to evaluate growth. We studied 672 consecutive surgical cases performed by our service for a sample period of 1 year, assessing referral patterns within and outside our medical center, anatomic region, surgical category, and surgical technique/tool. Academic productivity was measured by review of our service's publications. Results During the time period studied (2005-2013), outpatient and surgical volume significantly increased by 120% (1530 to 3372) and 105% (346 to 708), respectively, on our LDS. Surgical volume growth was similar to the overall growth of the department of orthopaedic surgery. Referrals were primarily from orthopaedic surgeons (56%) and self/Internet research (25%). Physician referrals were predominantly from our own medical center (83%). Referrals from within our institution came from a variety of clinical services. Forty-nine peer-reviewed articles and 23 book chapters were published by staff members of our service. Anatomic surgical sites, surgical categories, and technique/tools used on our LDS were diverse, yet procedures were specialized to the discipline of limb deformity. Conclusions There is a substantial role for an LDS within an academic department of orthopaedic surgery. With establishment of a dedicated service comes focus and resources that establish an environment for growth in volume, intramural and extramural referral, and purposeful research and education. The majority of referrals were from orthopaedic surgeons from our own medical center,

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Motorized Intramedullary Nail for Management of Limb-length Discrepancy and Deformity

Cited by 110 publications

References 19 publications

Total hip arthroplasty and femoral nail lengthening for hip dysplasia and limb-length discrepancy

Total hip arthroplasty and femoral nail lengthening for hip dysplasia and limb-length discrepancy

Use of internal lengthening nails in post-traumatic sequelae

What is the Utility Of a Limb Lengthening and Reconstruction Service in an Academic Department of Orthopaedic Surgery?

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