Radiographs of 366 removed limb-lengthening nails reveal differences in bone abnormalities between different nail types

Abstract

Aims Limb-lengthening nails have largely replaced external fixation in limb-lengthening and reconstructive surgery. However, the adverse events and high prevalence of radiological changes recently noted with the STRYDE lengthening nail have raised concerns about the use of internal lengthening nails. The aim of this study was to compare the prevalence of radiological bone abnormalities between STRYDE, PRECICE, and FITBONE nails prior to nail removal. Methods This was a retrospective case series from three centres. Patients were included if they had either of the three limb-lengthening nails (STYDE, PRECICE, or FITBONE) removed. Standard orthogonal radiographs immediately prior to nail removal were examined for bone abnormalities at the junction of the telescoping nail parts. Results In total, 306 patients (168 male, 138 female) had 366 limb-lengthening nails removed. The mean time from nail insertion to radiological evaluation was 434 days (36 to 3,015). Overall, 77% of STRYDE nails (20/26) had bone abnormalities at the interface compared with only 2% of FITBONE (4/242) and 1% of PRECICE nails (1/98; p < 0.001). Focal osteolysis in conjunction with periosteal reaction at the telescoping interface was only observed in STRYDE nails. Conclusion Bone abnormalities at the interface of telescoping nail parts were seen in the majority of STRYDE nails, but only very rarely with FITBONE or PRECICE nails. We conclude that the low prevalence of radiological changes at the junctional interface of 242 FITBONE and 98 PRECICE nails at the time of nail removal does not warrant clinical concerns. Cite this article: Bone Joint J 2021;103-B(11):1731–1735.

A clinical and radiological matched-pair analysis of patients treated with the PRECICE and STRYDE magnetically driven motorized intramedullary lengthening nails

“…However, they are limited in terms of comparability to other intramedullary lengthening systems. [8][9][10][11][12][13]15,21 This study was designed to provide a comprehensive approach in terms of clinical and radiological outcome of treatment with the conventional PRECICE and the STRYDE intramedullary lengthening nail. Compared to previous studies, a large and homogenous group of patients using a 2:1 matched-pair design was examined.…”

Does Focal Osteolysis in a PRECICE Stryde Intramedullary Lengthening Nail Resolve after Explantation?

“…Since a manufacturer recall in early 2021, multiple reports have demonstrated the presence of adverse tissue reactions in stainless-steel intramedullary lengthening nails [ 19 , 20 , 21 , 22 , 23 , 24 , 29 , 30 ]. In a report of three cases, Sax et al [ 19 ] demonstrated radiographic osteolysis in patients implanted with the stainless-steel nail with histologic confirmation of phagocytic activity of green-gold crystalline debris characteristic of metal debris.…”

“…They also found macroscopic corrosion at the modular junction in 83% of recipients, similar to that reported by our group in a previous publication [ 19 ] and a separate analysis of retrieved nails at another institution [ 30 ]. In a comparative study of multiple variations of an intramedullary limb lengthening nail, Iobst et al [ 29 ] observed a greater proportion of bone abnormalities at the modular junction of the STRYDE nail, as compared to the PRECICE or FITBONE (Orthofix Medical Inc., Lewisville, TX, USA). Given the current clinical understanding and relative dearth of data surrounding osteolysis at the modular junction of intramedullary limb lengthening nails, the existing reports are limited to descriptions of a pre-explantation process.…”

An Update on the Intramedullary Implant in Limb Lengthening: A Quinquennial Review Part 2: Extending Surgical Indications and Further Innovation

“…The most recent report compares the radiological changes associated with patients following lengthening with a Stryde, Precice or Fitbone nail [38] . They confirmed 77% of Stryde nails (20/26) had bone changes as reported above, at the site of the nail telescopic junction.…”