Tibial Bone Transport With a Single Implant All-Internal Bone Transport Nail

Abstract

A single implant all-internal magnet-driven bone transport nail (BTN-NuVasive Specialized Orthopaedics Inc) has recently been introduced as a treatment method for segmental tibial bone defects. This innovation provides promise in the management of segmental bone defects because it negates numerous complications associated with circular external fixation and the need for multiple implants when considering hybrid plate-assisted bone segment transport constructs. Given the novelty of the BTN, description of the surgical application and patient outcome measures are scarce in the current literature. To date, we have treated 4 patients with an average age of 27 years (range 19-44 years) using the BTN for segmental tibial defects ranging from 50 to 128 mm. We have accumulated data over an average follow-up of 18.07 months (range 12.96-25.13 months), demonstrating good patient tolerance of the device. Three patients successfully completed their treatment course with a calculated average bone healing index of 41.4 days/cm (range 31.41-54.82 days/cm). One patient was noted to experience an asymptomatic docking site nonunion requiring subsequent surgery for nonunion repair. Implant-associated complications included symptomatic implant, axial malalignment, docking site nonunion, and external remote control technical malfunction. Injury-related complications were encountered and noted to include: superficial infection, wound dehiscence, peroneal tendonitis, and joint rigidity. In this study, the authors present a case series using this implant to date and discuss our experiences with the BTN with reference to clinical indications, tibial bone preparation, BTN implantation, transport protocol, docking site procedure, and clinical/radiographic outcomes.

What’s New in Limb Lengthening and Deformity Correction

“…Two case series 15,16 examined the outcome of management of segmental defects of the tibia using a magnetically driven intramedullary transport nail. Blair et al described the surgical technique and reported on the outcome in 4 patients with a segmental tibial defect of at least 5 cm 15 . They reported complications of nonunion at the docking site, varus malalignment, and wound dehiscence.…”

“…Huang et al reported that their modified technique of acute shortening and double-level lengthening reduced the bone-lengthening time, time in the frame, external fixation index, and postoperative complications for patients with large tibial defects 14 . Two case series 15,16 examined the outcome of management of segmental defects of the tibia using a magnetically driven intramedullary transport nail. Blair et al described the surgical technique and reported on the outcome in 4 patients with a segmental tibial defect of at least 5 cm 15 .…”