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

Calder, Peter; Wright, Jonathan; Goodier, W. David

doi:10.1016/j.injury.2022.06.024

Cited by 3 publications

(1 citation statement)

References 33 publications

(40 reference statements)

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“…This involves analyzing the geometry and alignment of the leg, along with X-ray imaging, to determine suitability for limb lengthening. Factors like body weight are also considered to decide the appropriate osteotomy height [23][24][25][26][27].…”

Section: Osteogenesismentioning

confidence: 99%

Design and Testing of an Intramedullary Nail Implant Enhanced with Active Feedback and Wireless Connectivity for Precise Limb Lengthening

Kok,

Tan,

Koh

et al. 2024

Electronics

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This comprehensive study presents a pioneering approach to limb lengthening, leveraging the advancements in wireless technology to enhance orthopedic healthcare. Historically, limb lengthening has been a response to discrepancies caused by fractures, diseases, or congenital defects, utilizing the body’s innate ability to regenerate bone and surrounding tissues. Traditionally, this involved external or internal fixation devices, such as the Ilizarov and Taylor Spatial frames or the Precice nail and Fitbone. The focal point of this research is the development and testing of a wireless intramedullary nail implant prototype, controlled remotely via a mobile application. This implant comprises a microcontroller, Bluetooth Low Energy module, a brushed DC motor controlled through an H-bridge, and a force sensor, all powered by medical-grade batteries. The integration of wireless technology facilitates patient autonomy in managing limb lengthening, reducing the need for frequent clinical visits. The methodology involves a detailed block diagram for our proposed work, outlining the process from treatment planning to the initiation of limb lengthening via the mobile application. Osteogenesis, the formation of new bone tissue, plays a crucial role in this procedure, which includes pre-surgery assessment, osteotomy, latency, distraction, consolidation, and removal phases. Key challenges addressed include custom battery design for efficient operation, size constraints, and overcoming signal interference due to the Faraday cage effect. Attenuation testing, simulating human tissue interaction, validates the implant’s connectivity. In conclusion, this research marks a significant stride in orthopedic care, demonstrating the feasibility of a wireless implant for limb lengthening. It highlights the potential benefits of reduced clinical visits, cost efficiency, and patient convenience. Despite limitations such as battery requirements and signal interference, this study opens avenues for future enhancements in patient-centered orthopedic treatments, signaling a transformative shift in managing limb length discrepancies.

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Section: Osteogenesismentioning

confidence: 99%

Design and Testing of an Intramedullary Nail Implant Enhanced with Active Feedback and Wireless Connectivity for Precise Limb Lengthening

Kok,

Tan,

Koh

et al. 2024

Electronics

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PRECICE nail for the management of posttraumatic bone defects with nonunion or malunion: Experience from a Latin American center

Zuluaga,

Pérsico,

Medina

et al. 2023

Injury

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Total Hip Replacement and Femoral Nail Lengthening for Hip Dysplasia and Limb Length Discrepancy: A Literature Review

Athanasiou,

Papagiannis,

Antzoulas

et al. 2024

Cureus

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Developmental dysplasia of the hip (DDH) is a serious condition resulting in inadequate acetabular development, distorted bone configuration, and substantially altered hip biomechanics. An extensive leg length discrepancy (LLD) is commonly encountered in such cases, making a total hip arthroplasty (THA) procedure extremely challenging. Although good results in terms of patients’ satisfaction, implant survival rates and overall improved quality of life have been reported, complication rates are considerably higher than primary THA procedures performed for idiopathic osteoarthritis. Reconstructing a dysplastic hip arthrosis and equalizing a preexisting LLD is a technically demanding procedure that is associated with significant bone and soft tissue complications. Intramedullary lengthening through motorized nails has become increasingly popular to address difficult cases with extensive LLD following THA in recent years. However, limited data on femoral lengthening procedures implemented following THA are available considering complications, radiological results, and patient-reported outcomes following staged THA and subsequent femoral lengthening using a femoral magnetically-driven intramedullary lengthening nail. We performed a literature review of the past 10 years in PubMed using the terms neglected hip dislocation, DDH, THA, and intramedullary lengthening nail as keywords. A total amount of eight cases addressing LLD through a telescoping intramedullary nail following THA in DDH have been reported in recent literature. All eight patients underwent primary THA for DDH followed by the implantation of the intramedullary lengthening nail. The mean THA was lengthened by 28.9 mm (from 13.0 to 45.0). The mean time for nail implantation after THA was 11.1 months (from 3.5 to 21). The mean time for lengthening per day through the nail was 0.94 mm (from 0.65 to 1.0) from 26 days to 70 days, and the mean lengthening through the nail was 37.6 mm (from 24.0 to 70.0). Good union and consolidation rates were reported by the authors, while there were no complications. The intramedullary distraction osteogenesis method with a telescopic rod can be an effective method to manage leg length discrepancies while avoiding soft tissue complications in challenging cases of DDH.

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

Cited by 3 publications

References 33 publications

Design and Testing of an Intramedullary Nail Implant Enhanced with Active Feedback and Wireless Connectivity for Precise Limb Lengthening

Design and Testing of an Intramedullary Nail Implant Enhanced with Active Feedback and Wireless Connectivity for Precise Limb Lengthening

PRECICE nail for the management of posttraumatic bone defects with nonunion or malunion: Experience from a Latin American center

Total Hip Replacement and Femoral Nail Lengthening for Hip Dysplasia and Limb Length Discrepancy: A Literature Review

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