The PRECICE magnetic IM compression nail for long bone nonunions: a preliminary report

Abstract

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.

A novel bone graft technique combined with plating for aseptic recalcitrant long bone nonunion

“…Intramedullary nailing is mainly used to treat long bone nonunion with slight movement.Many successful clinical studies have con rmed that intramedullary nailing is effective in the treatment of aseptic long bone nonunion (22,23).However, a meta-analysis of exchange nail and augmentative plate in the treatment of long bone nonunion showed that the bone union rate, the time to union, intra-operative blood loss and operative time of plate were better than those of intramedullary nail (24).Moreover, in this study, most patients form synovial pseudarthrosis. The treatment of such patients needs to completely remove the pseudocapsule and hardened sequestrum between the fracture site, so intramedullary nails may not be suitable for the patients in this study.…”

STRYDE versus PRECICE magnetic internal lengthening nail for femur lengthening

“…When the PRECICE ® MILN [11][12][13][14][15][16][17][18][19][20][21][22] was first introduced in 2011, it took internal lengthening nailing to new heights as a telescoping rod that used an actuator drive mechanism to distract the titanium nail. It allowed surgeons to control distraction using an external remote with two revolving magnets that communicated with the magnet in the nail.…”

The PRECICE nail system: The initial Kuwaiti experience

“…This was in keeping with the literature. [35][36][37][38] The range of motion of the cohort in this study improved well without difficulties due to the hospital's aggressive physiotherapy regimen. There was no delay in bone consolidation in all of the cohort of this study.…”