Download PDF
CC BY-NC-ND 4.0 · Revista Chilena de Ortopedia y Traumatología 2020; 61(02): 060-068
DOI: 10.1055/s-0040-1715160
Original Article | Artículo Original

Alargamiento Oseo Con Clavo Intramedular Magnetico Experiencia Preliminar y Lecciones Aprendidas

Bone Lengthening with Magnetic Intramedullary Nail Preliminary Experience and Learned Lessons
Alejandro Baar-Zimend 
1   Jefe de la Unidad Ortopedia Y Traumatologia Infantil Clinica Las Condes, Santiago, Region Metropolitana, Chile
› Author Affiliations
› Further Information
   Permissions and Reprints

Resumen

Objetivos Mostrar resultados, complicaciones y lecciones aprendidas utilizando el clavo intramedular magnético (IML, Intramedullary Magnetic Lengthener) en un grupo de pacientes sometidos a alargamiento óseo.

Pacientes y Métodos Entre enero 2017 y diciembre 2019, 9 pacientes (15 segmentos), edad entre 15 y 39 años, fueron sometidos a alargamiento óseo con IML: 5 pacientes tuvieron alargamiento femoral bilateral por talla baja, 1 paciente se sometió a alargamiento de Piernas bilateral por Tibia vara y acortamiento mesomélico y 3 recibieron alargamientos femorales unilaterales por discrepancia de longitud de extremidades. Todos fueron operados por el mismo cirujano, con técnica standard. Se indicó kinesiterapia al menos 5 veces por semana durante la fase de distracción.

Resultados En todos se logró el objetivo de alargamiento planteado. No hubo complicaciones intra ni postoperatorias graves (TVP, TEP, Embolia grasa), ni fallas del sistema distractor. Un paciente desarrolló contracturas articulares de ambas rodillas por no adhesión a Kinesiterapia. Ninguno requirió aporte de injerto óseo, sin embargo en 2 pacientes de alargamiento de Fémur bilateral, se presentó deformidad en varo, que hizo necesario recambio a clavo convencional y un paciente desarrolló una parálisis transitoria del Nervio Peroneo común.

Conclusiones El advenimiento de los IML significó un gran avance en el campo de la osteogènesis por distracción, sin embargo, aún se trata de un procedimiento complejo, que debe ser planificado cuidadosamente para minimizar los riesgos y complicaciones. Una selección meticulosa del paciente y la evaluación física y psicológica previa, son fundamentales para el éxito del procedimiento. Los casos bilaterales requieren de un seguimiento cercano, por el riesgo de falla del implante.

Abstract

Objective We show our results, complications and lessons learned using the Intramedullary Magnetic Lengthener (IML) in a group of patients who were subjected to bone lengthening.

Patients and Methods Between January 2017 and December 2019, 9 patients (15 segments), aged between 15 and 39 years, underwent bone lengthening with IML: 5 patients had bilateral femoral lengthening due to short stature, 1 patient had bilateral leg lengthening due to Tibia vara and mesomelic shortening and 3 had unilateral femoral lengthening for limb length discrepancy. All were operated by the same surgeon, with standard technique. Physical therapy was indicated at least 5 times per week during the distraction phase.

Results In every case, the proposed lengthening amount was achieved. There were no serious intraoperative or postoperative complications (DVT, Pulmonary Embolism, Fat Embolism), nor failures of the distractor system. One patient developed knee joint contracture due to non-adherence to Physical therapy. None required bone grafting, however, in 2 patients with bilateral Femur, a varus deformity appeared, which required nail exchange with a conventional trauma nail. One case developed a transit common Peroneal Nerve palsy.

Conclusions IMLs represent a great advance in the bone lengthening realm, however, it is still a complex procedure, which must be carefully planned to minimize risks and complications. Meticulous patient selection and prior physical and psychological evaluation are essential to the success of the procedure. Bilateral cases need a closer follow up, because implant failure is a potential risk.

Palabras clave

alargamiento óseo - osteogénesis por distracción - clavo intramedular magnético

Keywords

bone lengthening - distraction osteogenesis - magnetic intramedullary nail


Publication History

Received: 13 April 2020

Accepted: 19 June 2020

Article published online:
10 August 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Revinter Publicações Ltda
Rio de Janeiro, Brazil

 

  • Bibliografía

  • 1 Codivilla A. On the means of lengthening in the lower limbs, the muscles, and tissues which are shortened through deformity. Am J Orthop Surg (Phila Pa) 1905; 2: 353-369
    PubMedGoogle Scholar
  • 2 Gubin AV, Borzunov DY, Marchenkova LO, Malkova TA, Smirnova IL. Contribution of G.A. Ilizarov to bone reconstruction: historical achievements and state of the art. Strateg Trauma Limb Reconstr 2016; 11 (03) 145-152
    CrossrefPubMedGoogle Scholar
  • 3 Paley D. Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop Relat Res 1990; (250) 81-104
    PubMedGoogle Scholar
  • 4 Dahl MT, Gulli B, Berg T. Complications of limb lengthening. A learning curve. Clin Orthop Relat Res 1994; (301) 10-18
    PubMedGoogle Scholar
  • 5 Griffith SI, McCarthy JJ, Davidson RS. Comparison of the complication rates between first and second (repeated) lengthening in the same limb segment. J Pediatr Orthop 2006; 26 (04) 534-536
    CrossrefPubMedGoogle Scholar
  • 6 Hosny GA. Limb lengthening history, evolution, complications and current concepts. J Orthop Traumatol 2020; 21 (01) 3
    CrossrefPubMedGoogle Scholar
  • 7 Calder PR, Laubscher M, Goodier WD. The role of the intramedullary implant in limb lengthening. Injury 2017; 48 (Suppl. 01) S52-S58
    CrossrefPubMedGoogle Scholar
  • 8 Betz A, Baumgart R, Schweiberer L. Erstes voll implantierbares intramedulläres System zur Callusdistraktion--Marknagel mit programmierbarem Antrieb zur Beinverlängerung und Segmentverschiebung. Grundlagen und erste klinische Ergebnisse. [First fully implantable intramedullary system for callus distraction–intramedullary nail with programmable drive for leg lengthening and segment displacement. Principles and initial clinical results] Chirurg 1990; 61 (08) 605-609
    PubMedGoogle Scholar
  • 9 Paley D. PRECICE intramedullary limb lengthening system. Expert Rev Med Devices 2015; 12 (03) 231-249
    CrossrefPubMedGoogle Scholar
  • 10 Fragomen AT, Rozbruch SR. Retrograde magnetic internal lengthening nail for acute femoral deformity correction and limb lengthening. Expert Rev Med Devices 2017; 14 (10) 811-820
    CrossrefPubMedGoogle Scholar
  • 11 Iobst CA, Rozbruch SR, Nelson S, Fragomen A. Simultaneous Acute Femoral Deformity Correction and Gradual Limb Lengthening Using a Retrograde Femoral Nail: Technique and Clinical Results. J Am Acad Orthop Surg 2018; 26 (07) 241-250
    CrossrefPubMedGoogle Scholar
  • 12 Horn J, Hvid I, Huhnstock S, Breen AB, Steen H. Limb lengthening and deformity correction with externally controlled motorized intramedullary nails: evaluation of 50 consecutive lengthenings. Acta Orthop 2019; 90 (01) 81-87
    CrossrefPubMedGoogle Scholar
  • 13 Steiger CN, Lenze U, Krieg AH. A new technique for correction of leg length discrepancies in combination with complex axis deformities of the lower limb using a lengthening nail and a locking plate. J Child Orthop 2018; 12 (05) 515-525
    CrossrefPubMedGoogle Scholar
  • 14 Lenze U, Krieg AH. Intramedullary lengthening nails: can we also correct deformities?. J Child Orthop 2016; 10 (06) 511-516
    CrossrefPubMedGoogle Scholar
  • 15 Muthusamy S, Rozbruch SR, Fragomen AT. The use of blocking screws with internal lengthening nail and reverse rule of thumb for blocking screws in limb lengthening and deformity correction surgery. Strateg Trauma Limb Reconstr 2016; 11 (03) 199-205
    CrossrefPubMedGoogle Scholar
  • 16 Hammouda AI, Jauregui JJ, Gesheff MG, Standard SC, Herzenberg JE. Trochanteric Entry for Femoral Lengthening Nails in Children: Is It Safe?. J Pediatr Orthop 2017; 37 (04) 258-264
    CrossrefPubMedGoogle Scholar
  • 17 Frommer A, Rödl R, Gosheger G, Vogt B. Anwendung motorisierter Verlängerungsmarknägel am wachsenden Skelett : Indikationsspektrum und Limitationen. [Application of motorized intramedullary lengthening nails in skeletally immature patients: Indications and limitations] Unfallchirurg 2018; 121 (11) 860-867
    CrossrefPubMedGoogle Scholar
  • 18 Gordon JE, Manske MC, Lewis TR, O'Donnell JC, Schoenecker PL, Keeler KA. Femoral lengthening over a pediatric femoral nail: results and complications. J Pediatr Orthop 2013; 33 (07) 730-736
    CrossrefPubMedGoogle Scholar
  • 19 Gordon JE, Swenning TA, Burd TA, Szymanski DA, Schoenecker PL. Proximal femoral radiographic changes after lateral transtrochanteric intramedullary nail placement in children. J Bone Joint Surg Am 2003; 85 (07) 1295-1301
    CrossrefPubMedGoogle Scholar
  • 20 Richardson SS, Schairer WW, Fragomen AT, Rozbruch SR. Cost Comparison of Femoral Distraction Osteogenesis With External Lengthening Over a Nail Versus Internal Magnetic Lengthening Nail. J Am Acad Orthop Surg 2019; 27 (09) e430-e436
    CrossrefPubMedGoogle Scholar
  • 21 Paley D, Harris M, Debiparshad K, Prince D. Limb lengthening by implantable limb lengthening devices. Tech Orthop 2014; 29 (02) 72-85
    CrossrefPubMedGoogle Scholar
  • 22 Paley D, Debiparshad K, Balci H, Windisch W, Lichtblau C. Stature Lengthening Using the PRECICE Intramedullary Lengthening Nail. Tech Orthop 2015; 30 (03) 167-182
    CrossrefPubMedGoogle Scholar
  • 23 Calder PR, McKay JE, Timms AJ. , et al. Femoral lengthening using the Precice intramedullary limb-lengthening system: outcome comparison following antegrade and retrograde nails. Bone Joint J 2019; 101-B (09) 1168-1176
    CrossrefPubMedGoogle Scholar
  • 24 Wagner P, Burghardt RD, Green SA, Specht SC, Standard SC, Herzenberg JE. PRECICE® magnetically-driven, telescopic, intramedullary lengthening nail: pre-clinical testing and first 30 patients. SICOT J 2017; 3: 19
    CrossrefPubMedGoogle Scholar
  • 25 Paley D, Windisch W. Cosmetic limb lengthening for stature: Ethics, Methods and Results. Perth, Australia: Australian Orthopaedic Association; 2005
    Google Scholar
  • 26 Williams J, Gibbons M, Trundle H, Murray D, Worlock P. Complications of nailing in closed tibial fractures. J Orthop Trauma 1995; 9 (06) 476-481
    CrossrefPubMedGoogle Scholar
  • 27 Hems TE, Jones BG. Peroneal nerve damage associated with the proximal locking screws of the AIM tibial nail. Injury 2005; 36 (05) 651-654 , discussion 655
    CrossrefPubMedGoogle Scholar
  • 28 Drosos GI, Stavropoulos NI, Kazakos KI. Peroneal nerve damage by oblique proximal locking screw in tibial fracture nailing: a new emerging complication?. Arch Orthop Trauma Surg 2007; 127 (06) 449-451
    CrossrefPubMedGoogle Scholar