Abstract:Background Although several systems exist for classifying specific limb deformities, there currently are no validated rating scales for evaluating the complexity of general lower limb deformities. Accurate assessment of the complexity of a limb deformity is essential for successful treatment. A committee of the Limb Lengthening and Reconstruction Society (LLRS) therefore developed the LLRS AIM Index to quantify the severity of a broad range of lower extremity deformities in seven domains.Questions/Purposes We … Show more
“… Case # patient case #, M male, F female, Seg segment, T tibia, F femur, Opioid opioid addiction/chronic pain, DM1 diabetes mellitus type 1, DM2 diabetes mellitus type 2, ESRD end stage renal disease, CHF congestive heart failure, Fx fracture, GA Gustilo–Anderson [23], O open fracture, C closed, Rx treatment, IMN intramedullary nail, CP compression plating, BT bone transport, CEF circular external fixation, ICN internal compression nailing, NU nonunion, N normotrophic, A atrophic, AIM AIM score [24] with 7.7 representing moderate complexity…”
Section: Methodsmentioning
confidence: 99%
“…2a, b) All complications were recorded. AIM scores were collected to gauge the complexity of the impending reconstruction [24]. Fig.…”
IntroductionThe magnetic intramedullary (IM) compression nail is capable of providing sustained compression for the treatment of nonunions of long bones. This ability was previously only possible with the use of external fixation. We asked the following questions: How effective is the IM compression nail at achieving union? How do we know when adequate compression has been attained? Which types of nonunions are good candidates for this treatment?Materials and methodsFourteen patients with nonunions of the tibia (5) or femur (9) were treated with the PRECICE IM compression nail. The average age was 49 years number of previous surgeries was 1.9, 7 were atrophic and 7 normotrophic, 3 were metaphyseal and 11 diaphyseal. All PRECICE IM nails were pre-distracted prior to implantation. Compression was applied post-operatively until the locking bolts were seen on X-ray to be bending or the nail was no longer shortening despite applying the external magnet.ResultsUnion was achieved in 13/14 cases. The time to union was 24.5 weeks (range 11–60). The two proximal tibia metaphyseal nonunions, both deformed into varus (4°) and flexion (10°) after compression was applied with one failing to unite. The distal tibia metaphyseal and diaphyseal nonunions did not deform upon compression. Three patients had positive cultures and were treated with IV antibiotics for 6 weeks followed by 3 months of oral suppression without subsequent infection. No mechanical nail failures were seen.ConclusionsThe IM compression nail was successful at applying compression, preventing deformity, and obtaining union in all diaphyseal and in distal tibia metaphyseal nonunions. Signs of active compression are bending of the locking bolts and failure of the nail to shorten. Proximal tibia metaphyseal nonunion may not be suited for this treatment.
“… Case # patient case #, M male, F female, Seg segment, T tibia, F femur, Opioid opioid addiction/chronic pain, DM1 diabetes mellitus type 1, DM2 diabetes mellitus type 2, ESRD end stage renal disease, CHF congestive heart failure, Fx fracture, GA Gustilo–Anderson [23], O open fracture, C closed, Rx treatment, IMN intramedullary nail, CP compression plating, BT bone transport, CEF circular external fixation, ICN internal compression nailing, NU nonunion, N normotrophic, A atrophic, AIM AIM score [24] with 7.7 representing moderate complexity…”
Section: Methodsmentioning
confidence: 99%
“…2a, b) All complications were recorded. AIM scores were collected to gauge the complexity of the impending reconstruction [24]. Fig.…”
IntroductionThe magnetic intramedullary (IM) compression nail is capable of providing sustained compression for the treatment of nonunions of long bones. This ability was previously only possible with the use of external fixation. We asked the following questions: How effective is the IM compression nail at achieving union? How do we know when adequate compression has been attained? Which types of nonunions are good candidates for this treatment?Materials and methodsFourteen patients with nonunions of the tibia (5) or femur (9) were treated with the PRECICE IM compression nail. The average age was 49 years number of previous surgeries was 1.9, 7 were atrophic and 7 normotrophic, 3 were metaphyseal and 11 diaphyseal. All PRECICE IM nails were pre-distracted prior to implantation. Compression was applied post-operatively until the locking bolts were seen on X-ray to be bending or the nail was no longer shortening despite applying the external magnet.ResultsUnion was achieved in 13/14 cases. The time to union was 24.5 weeks (range 11–60). The two proximal tibia metaphyseal nonunions, both deformed into varus (4°) and flexion (10°) after compression was applied with one failing to unite. The distal tibia metaphyseal and diaphyseal nonunions did not deform upon compression. Three patients had positive cultures and were treated with IV antibiotics for 6 weeks followed by 3 months of oral suppression without subsequent infection. No mechanical nail failures were seen.ConclusionsThe IM compression nail was successful at applying compression, preventing deformity, and obtaining union in all diaphyseal and in distal tibia metaphyseal nonunions. Signs of active compression are bending of the locking bolts and failure of the nail to shorten. Proximal tibia metaphyseal nonunion may not be suited for this treatment.
“…All represented off-label uses of the device. Limb Lengthening and Reconstruction Society (LLRS) AIM Index was used to classify deformity severity in the current cohort [24].…”
IM lengthening nails can provide successful and safe humeral lengthening. Specifically, the PRECICE nail has accurate control over the lengthening process.
“…To quantify the severity of the limb deformity of each patient, we used the Limb Lengthening and Reconstruction Society AIM index [24] before the lengthening procedure. All patients were classified as minimal complexity at the moment of the lengthening procedure.…”
Background Patients with congenital limb shortening can present with joint instability, soft tissue contractures, and significant leg length discrepancy. Classically, lengthening is done with external fixation, which can result in scarring, pin site infection, loss of motion, and pain. We therefore developed an alternative to this approach, a new, controllable, internal lengthening device for patients with congenital limb shortening.
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