Complications of Limb Lengthening With Motorized Intramedullary Nails

Abstract

Intramedullary limb lengthening (LL) is now achievable through motorized intramedullary devices. While this technology mitigates some complications of external-fixation-based lengthening, many complications common to all lengthening procedures persist. New challenges and complications exclusive to this newer technology are also presented. The LL surgeon should be aware of and ready to respond to complications involving device malfunctions, poor local bony and soft-tissue biology, patient compliance, neurovascular compromise, joint instability, regenerate problems, and others. While technology will continue to evolve, study of and adherence to foundational principles of LL will minimize risks and optimize patient outcomes.

Lengthening the Lower Extremities of Children with Ollier’s and Maffucci’s Enchondromatosis Using Implantable Lengthening Nails

“…Complications included joint stiffness (the most common), infection (mostly related to the pin sites), early healing of the lengthening site, fracture, recurrence of deformity, delayed/non-union, neuropraxia and overlengthening. These complications have been documented in other reviews of lengthening [18,19]. In our series, one patient experienced a knee extension contracture and another patient experienced premature consolidation which led to nail migration.…”

Pain, osteolysis, and periosteal reaction are associated with the STRYDE limb lengthening nail: a nationwide cross-sectional study

“…in 2015) and the stainless-steel lengthening nail, Fitbone (Orthofix, Lewisville, TX, USA) have been on the market for many years. The growing body of literature regarding complications of all internal limb lengthening does not state any similar adverse events (Calder et al 2019 , Frost et al 2021 , Morrison et al 2020 , Thaller et al 2020 , Iliadias et al 2021). However, the current MHRA recommendations not to implant the PRECICE P2.2 as well as scientific scrutiny demand retrospective studies evaluating whether this phenomenon/adverse event also exists on a lower scale with these products.…”

“…Onset of pain at late stages of limb lengthening, i.e., consolidation of the regenerate, should warrant immediate radiographic examination regarding osteolysis, periosteal reaction, and cortical hypertrophy, which may be associated with discoloration (potential corrosion) of the nail. We recommend removal of Stryde implants as early as possible after consolidation Bone reconstruction and lengthening surgery entails many risks and unplanned surgeries are common (Frost et al 2021, Morrison et al 2020, Sheridan et al 2020. However, since many adverse events can be managed with or without surgical intervention without affecting the long-term outcome, Paley (1990) redefined complications by subdividing these adverse events into problems, obstacles, and complications.…”

“…Bone reconstruction and lengthening surgery entails many risks and unplanned surgeries are common (Frost et al 2021 , Morrison et al 2020 , Sheridan et al 2020 ). However, since many adverse events can be managed with or without surgical intervention without affecting the long-term outcome, Paley ( 1990 ) redefined complications by subdividing these adverse events into problems, obstacles, and complications.…”

The STRYDE limb lengthening nail is susceptible to mechanically assisted crevice corrosion: an analysis of 23 retrieved implants

“…Interestingly, Lee et al (2017) describe broken bushings of PRECICE nails, but no corrosion. However, based on these studies and the body of evidence, clinical application of the titanium PRECICE nail is relatively safe (Alrabai et al 2017, Calder et al 2019, Horn et al 2019, Hammouda et al 2020, Morrison et al 2020, Nasto et al 2020, Frost et al 2021, Iliadis et al 2021b.…”