Outcomes following femoral lengthening

Laubscher, Maritz; Mitchell, C. Leslie; Timms, A; Goodier, David; Calder, Peter

doi:10.1302/0301-620x.98b10.36643

Cited by 101 publications

(80 citation statements)

References 30 publications

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“…It has also been shown to have improved patient satisfaction and faster regenerate consolidation when compared with femoral lengthening using external fixators. 12 There has been modification of the initial design to strengthen the nail, following breakage through implant welds (P1) and subsequent crown failures (P2, initially designed to control rotation), which has led to the current P2.1. The actuator pins were also increased in size to withstand the forces required during lengthening.…”

Section: Discussionmentioning

confidence: 99%

A retrieval analysis of the Precice intramedullary limb lengthening system

Panagiotopoulou

Davda

Hothi

et al. 2018

Bone & Joint Research

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ObjectivesThe Precice nail is the latest intramedullary lengthening nail with excellent early outcomes. Implant complications have led to modification of the nail design. The aim of this study was to perform a retrieval study of Precice nails following lower-limb lengthening and to assess macroscopical and microscopical changes to the implants and evaluate differences following design modification, with the aim of identifying potential surgical, implant, and patient risk factors.MethodsA total of 15 nails were retrieved from 13 patients following lower-limb lengthening. Macroscopical and microscopical surface damage to the nails were identified. Further analysis included radiology and micro-CT prior to sectioning. The internal mechanism was then analyzed with scanning electron microscopy and energy dispersive x-ray spectroscopy to identify corrosion.ResultsSeven male and three female patients underwent 12 femoral lengthenings. Three female patients underwent tibial lengthening. All patients obtained the desired length with no implant failure. Surface degradation was noted on the telescopic part of every nail design, less on the latest implants. Microscopical analysis confirmed fretting and pitting corrosion. Following sectioning, black debris was noted in all implants. The early designs were found to have fractured actuator pins and the pin and bearings showed evidence of corrosive debris. The latest designs showed evidence of biological deposits suggestive of fluid ingress within the nail but no corrosion.ConclusionThis study confirms less internal corrosion following modification, but evidence of titanium debris remains. We recommend no change to current clinical practice. However, potential reuse of the Precice nail, for secondary limb lengthening in the same patient, should be undertaken with caution.Cite this article: V. C. Panagiotopoulou, K. Davda, H. S. Hothi, J. Henckel, A. Cerquiglini, W. D. Goodier, J. Skinner, A. Hart, P. R. Calder. A retrieval analysis of the Precice intramedullary limb lengthening system. Bone Joint Res 2018;7:476–484. DOI: 10.1302/2046-3758.77.BJR-2017-0359.R1.

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Section: Discussionmentioning

confidence: 99%

A retrieval analysis of the Precice intramedullary limb lengthening system

Panagiotopoulou

Davda

Hothi

et al. 2018

Bone & Joint Research

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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].…”

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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“…Although it is well accepted that the Orthofix ProCallus fixator was designed to incorporate controlled axial compression at the fracture site [1,25], the LRS external fixator it is also often used in the dynamic compression mode. Actually, the LRS fixator is especially indicated for bone correction through the techniques of bone transport, compression-distraction, partial acute shortening and transport, multifocal surgery, and bifocal lengthening [5,13,15,16]. However, for these clinical situations, patients are encouraged to perform partial weight-bearing exercises, such as walking with crutches, as early as the third or fourth day after the surgery [5,14] and, afterward, in the consolidation phase, to promote dynamic compression of the callus; releasing one of the clamps from the fixator rail, while the others remains locked, allows the LRS fixator compression mode.…”

Section: Discussionmentioning

confidence: 99%

The Effect of External Fixator Configurations on the Dynamic Compression Load: An Experimental and Numerical Study

et al. 2019

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(1) Objective: External fixation systems are commonly used by surgeons to ensure stabilization and consolidation of bone fractures, especially in patients who are at high risk for systematic complications. Both rigid and elastic external fixations are important in the fracture healing process. This study aims to evaluate the behavior of the Orthofix Limb Reconstruction System (LRS)® in the dynamic compression mode. (2) Methods: Experimental and numerical setups were developed using a simplified model of a human tibia which consisted of a nylon bar with a diameter of 30 mm. The bone callus was included in both setups by means of a load cell-based system, which consisted of two carbon epoxy laminated composite plates with a final stiffness of 220 N/mm. The system was evaluated experimentally and numerically, considering different numbers of pins and comparing distances between the external fixator frame and the bone, achieving a good correlation between experimental and numerical results. (3) Results: The results identified and quantified the percental load transferred to the fracture and its sensibility to the distance between the external fixator and bone. Additionally, LRS locking stiffness was evaluated which resulted from the clamp-rail clearances. The results show that the blocking effects of the free clamp movement are directly related to the fixator configuration and are responsible for changes in the amount of load that crosses the bone callus. (4) Conclusions: From the biomechanical point of view, the results suggest that the average bending span of Schanz pins and the weights of the patients should be included into clinical studies of external fixators comparisons purpose.

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Outcomes following femoral lengthening

Abstract: Femoral lengthening with the Precice femoral nail achieved excellent functional results with fewer complications and greater patient satisfaction when compared with the LRS system in our patients. Cite this article: Bone Joint J 2016;98-B:1382-8.

Cited by 101 publications

References 30 publications

A retrieval analysis of the Precice intramedullary limb lengthening system

A retrieval analysis of the Precice intramedullary limb lengthening system

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

The Effect of External Fixator Configurations on the Dynamic Compression Load: An Experimental and Numerical Study

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