Experiences in the Use of Motorized Intramedullary Nails after Complex Injuries to the Extremities

Abstract

The treatment of complex injuries of the extremities after comminuted fractures or non-unions is a challenging area in the field of trauma surgery. Internal, motorized implants nowadays enable a patient-oriented and progressive treatment of these cases. The present article aims to present modern treatment strategies of complex injuries of the extremities, support the use of novel, motorized intramedullary nails and provide experiences for the handling with lengthening nails or transport nails. For this purpose, the preoperative planning including selection of patients, presentation of internal lengthening and transport systems and the most important factors during preparation of the surgery are described. Moreover, critical steps during the implantation of motorized nails and also during potential follow-up interventions are highlighted and the postoperative protocol including precise recommendations for the transport und consolidation phase are provided. Finally, the experiences are illustrated by presentation of the four different cases. The use of internal, motorized implants represents the latest step in the treatment of complex injuries of the extremities. These implants improve the quality of life and the authors recommend its use. However, these implants require a high expertise and adaption of established treatment protocols in these challenging trauma cases. Follow-up analyses with a considerably large number of cases are necessary and the research on implants to solve persisting problems in the area of complex injuries of the extremities has to be pursued intensively.

Keywords

complex trauma of the extremities - non-unions - motorized intramedullary nails - bone defect - segmental bone transport

Publication History

Received: 15 May 2021

Accepted after revision: 24 August 2021

Article published online:
01 February 2022

• Literatur

• 1 Rittstieg P, Wurm M, Müller M. et al. Aktuelle Versorgungsstrategien der Unterschenkelfraktur des Erwachsenen. Unfallchirurg 2020; 123: 479-490 DOI: 10.1007/s00113-020-00805-7. (PMID: 32399649)
• 2 Gage M, Liporace F, Egol K. et al. Management of Bone Defects in Orthopedic Trauma. Bull Hosp Jt Dis (2013) 2018; 76: 4-8 (PMID: 29537950)
• 3 Paley D, Herzenberg JE, Paremain G. et al. Femoral lengthening over an intramedullary nail. A matched-case comparison with Ilizarov femoral lengthening. J Bone Joint Surg Am 1997; 79: 1464-1480 DOI: 10.2106/00004623-199710000-00003.
• 4 Frommer A, Rödel R, Gosheger G. et al. Anwendung motorisierter Verlängerungsmarknägel am wachsenden Skelett: Indikationsspektrum und Limitationen. Unfallchirurg 2018; 121: 860-867 DOI: 10.1007/s00113-018-0541-4.
• 5 Morrison SG, Georgiadis AG, Huser AJ. et al. Complications of Limb Lengthening With Motorized Intramedullary Nails. J Am Acad Orthop Surg 2020; 28: 803-809 DOI: 10.5435/JAAOS-D-20-00064. (PMID: 32520902)
• 6 Serhan H, Slivka M, Albert T. et al. Is galvanic corrosion between titanium alloy and stainless steel spinal implants a clinical concern?. Spine J 2004; 4: 379-387 DOI: 10.1016/j.spinee.2003.12.004. (PMID: 15246296)
• 7 Keppler P, Kinzl L. Diagnostik der posttraumatischen Beindeformitäten. Trauma Berufskrankh 2006; 8: S303-S316 DOI: 10.1007/s10039-006-1188-x.
• 8 Paley D, Herzenberg JE, Tetsworth K. et al. Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am 1994; 25: 425-465 (PMID: 8028886)
• 9 Kähler Olesen U. „Plate-assisted segmental bone transport“ mit Verlängerungsnagel und Platte. Neue Technik zur Behandlung von Knochendefekten in Tibia und Femur. Unfallchirurg 2018; 121: 874-883 DOI: 10.1007/s00113-018-0546-z.
• 10 Krettek C. MagicTube: Neue Möglichkeiten zum komplett internen Knochensegmenttransport und optionaler Verlängerung. Neues Zusatzmodul für motorisierte Verlängerungsnägel zur Behandlung großer Knochendefekte. Unfallchirurg 2018; 121: 884-892 DOI: 10.1007/s00113-018-0549-9. (PMID: 30430224)
• 11 Thonse R, Conway J. Antibiotic cement-coated nails for the treatment of infected nonunions and segmental bone defects. J Bone Joint Surg Am 2008; 90 (Suppl. 04) S163-S174 DOI: 10.2106/JBJS.H.00753. (PMID: 18984728)
• 12 Birch JG. A Brief History of Limb Lengthening. J Pediatr Orthop 2017; 37 (Suppl. 02) S1-S8 DOI: 10.1097/BPO.0000000000001021. (PMID: 28799987)
• 13 Olesen UK, Nygaard T, Prince DE. et al. Plate-assisted Bone Segment Transport With Motorized Lengthening Nails and Locking Plates: A Technique to Treat Femoral and Tibial Bone Defects. J Am Acad Orthop Surg Glob Res Rev 2019; 3: e064 DOI: 10.5435/JAAOSGlobal-D-19-00064. (PMID: 31592010)