Presentations

Abstract

Introduction: Distraction osteogenesis is a technique that can be used for limb lengthening or managing segmental bone defects in individuals with deformities and/or limb length discrepancies following traumatic musculoskeletal injuries to induce new bone formation by means of bone lengthening and/or bone transport. It is achieved through the stimulation of tissue growth by applying slow, progressive traction at an osteotomy site. In the past, distraction osteogenesis has commonly been accomplished using external fixators, frames that have rods and nuts that can be manually adjusted to achieve distraction. The frame is attached with tensioned wires and pins to the patient's bones. Later, the 'lengthening over-nail' approach was introduced where an intramedullary nail and external fixators were used in conjunction. This method allows for better alignment of the bone throughout the lengthening/healing process and shortens the overall time in the frame. However, the use of an external fixator is not well tolerated by many patients due to the external hardware and is frequently associated with pin site infections. A magnetic lengthening nail (e.g. Precice nail) is a newer technology that has been developed to achieve distraction osteogenesis and is composed of a magnet, motor, and extendible rod. The nail system is activated via an external device that allows a patient to gradually achieve a lengthening goal with consistent use.

Methods: This quality improvement project evaluated patient outcomes following Precice nail procedures. A retrospective chart review was conducted to identify Bellevue Hospital patients that had lower extremity procedures involving Precice nails between 2022-2024. All patients who had an exchange nail procedure or nail removal were analyzed as this indicated completion of lengthening/bone transport with the magnetic nail.

Results: Following chart review, 7 patients were identified as having prior lower extremity surgeries utilizing the Precice nail. Six of the seven patients underwent exchange nailing to a weightbearing trauma nail and one only underwent nail removal. On average, Precice nail patients had 3 surgeries related to the Precice nail including insertion, revision, and removal/exchange procedures. The average length of the patients' nonweightbearing period following initial Precice nail insertion was 4 months. The average time to completion of the bone lengthening/bone transport process was 5 months. When the patient's bone lengthening/bone transport was complete, the Precice nail was exchanged for an intramedullary trauma nail. For 2 of the patients the exchange nail was their final surgery related to the Precice nail. However, 4 patients had complications that required additional unplanned surgeries. These complications included delayed bone healing requiring bone grafting, surgical site infection requiring irrigation and debridement, as well as knee stiffness and equinus contracture requiring soft tissue releases.

Conclusion: Given the recent adoption of Precice nail procedures evaluated in this project, a longer follow-up period is needed before further conclusions can be made and patient outcomes following Precice nailing can be evaluated. For next steps, the authors plan to compare the preliminary Precice nail patient results to those of previous patients treated with external fixators. The authors will compare factors such as average number of surgeries, time to completion of lengthening/bone transport, length of nonweightbearing period, number of unplanned secondary procedures, time to bony union, and complications.