Limb lengthening with PRECICE magnetic nail in pediatric patients: A systematic review

Abstract

BACKGROUND Limb lengthening techniques play an increasingly important role in the pediatric orthopedic field. The principles of the osteogenesis distraction bonded traditionally with external fixators; however, the recent deployment of fully implantable systems has been able to overcome severities related to external fixators. The PRECICE ® is an implantable limb lengthening intramedullary nail system that is remotely controlled and magnetically driven. AIM To review the current literature available on this matter in order to assess the PRECICE clinical and radiological outcomes and its possible complications in a population of pediatric patients undergoing limb lengthening. METHODS Only five studies met the inclusion criteria and were consequently included in the review for a total of 131 patients and 135 femurs. The clinical and radiological outcomes of interest were: the main lengthening obtained, the distraction rate, the period of time to full weight bearing, the consolidation index, and the Association for the Study and Application of Methods of Ilizarov score. RESULTS In conclusion, data collected from the articles under investigation were comparable with the exception of the consolidation index. Unfortunately, the study population was too small and the patients’ follow-up was too short to make definitive conclusions. CONCLUSION This review shows that the PRECICE Nail System is still a therapeutic challenge in limb lengthening for pediatric orthopedic surgeons; however, careful pre-operative planning and an accurate surgical technique could allow the correction of more complex deformities with a low rate of complications.

Evaluation of simultaneous bilateral femoral distraction osteogenesis with antegrade intramedullary lengthening nails in achondroplasia with rhizomelic short stature: a retrospective study of 15 patients with a minimum follow-up of 2 years

“…In this study, the median distraction index was 1.0 mm/day (IQR 0.9-1.0). Previous studies have found similar distraction indices ranging from 0.7 to 0.9 mm/day [17,18,23,25]. Interestingly, the median consolidation index in this study of 20 days/cm (IQR [17][18][19][20][21][22][23] [12,16,18,19,23,26].…”

What’s new in pediatric lower limb reconstruction?

“…Antegrade femoral nails might be used in skeletally immature patients by using a trochanteric entry point; however, the age limit for avoiding avascular necrosis of the femoral head is unknown. A systematic review 19 of five studies 13,14,[20][21][22] with 131 patients ranging from 7 to 18 years of age did not report radiographic nor clinical signs of femoral head necrosis when using the trochanteric entry in 135 femoral lengthenings. In very young patients, off-label extramedullary use of the lengthening nails has allowed for internal femoral lengthening in patients as young as 4 years of age.…”

Beyond the gut: spectrum of magnetic surgery devices

“…The internal actuator is activated by an external remote controller containing two neodymium magnets which control the distraction rate ( 34 , 37 ). In the pediatric population, this device has a reported mean lengthening range of 4.4–5.6 cm with nail accuracy (i.e., ratio of actual lengthening to planned lengthening) ranging from 91%–96% ( 38 ). While this device's use of the magnetic driving technique proves to be a feasible alternative to current motorized non-magnetic systems for the treatment of limb length discrepancy, limitations include device complications requiring surgical intervention (e.g., joint subluxation, delayed regenerate union, infection, nail fracture) and a wide variation in time to full weight bearing (range 21–132 days) ( 37 – 40 ).…”