Technical considerations for the management of segmental osseous defects with an internal bone transport nail

ABSTRACT

Introduction

Traditionally, distraction osteogenesis has been accomplished with an external fixator. All internal transport utilizing magnetic intramedullary nails is a newer technique for bone reconstruction. The Precice Bone Transport Nail is a new implant that allows for noninvasive transport via a magnetically driven motor.

Areas covered

This report describes the function of the Bone Transport Nail along with the technical considerations on how to successfully manage bone defects with this new technology. Appropriate use of the nail, preoperative planning, intraoperative considerations, and postoperative management are discussed in detail.

Expert opinion

The Precice Bone Transport Nail utilizes the technology of the original Precice nail to provide an all-internal option for reconstruction of intercalary defects. This obviates the need for an additional plate with a standard Precice nail when performing bone transport and allows for a less invasive option that decreases operating room time. It provides a more cosmetic result than external fixation and avoids the risks of pin tract infection. Preoperative planning is essential to appropriate execution of the operative procedure and to perform a successful transport. A thorough understanding of the nail design and limitations are a prerequisite as this implant is significantly different from a standard intramedullary nail.

KEYWORDS:

• Bone loss
• distraction osteogenesis
• intercalary defect
• limb-salvage
• metastatic disease
• nonunion
• Precice bone transport nail
• sarcoma

Article highlights

• Pre-operative planning is essential to choose the correct nail length, establish whether a screw exchange or pit stop is required, and to plan the location of the corticotomy to maximize transport.

• The corticotomy should be made carefully as comminution or propagation of a fracture may compromise screw fixation.

• Blocking screws should be planned and placed as needed to aid in proper nail placement and prevent iatrogenic deformity.

• Cables can be used to assist in transport of the intercalary segment when screws are not able to be placed.

• The weight limits of the nail should be strictly followed to prevent catastrophic failure of the nail.

• Regularly scheduled radiographs are necessary during transport to ensure adequate regenerate formation, decrease the risk of early consolidation, and to adjust the transport rate if necessary.

Declaration of Interest

LM Zuckerman is a paid consultant and paid speaker for NuVasive Specialized Orthopedics; and has received research support from Onkos Surgical. JA Scolaro is a paid consultant for NuVasive Specialized Orthopedics, Smith & Nephew, Stryker and Zimmer; and receives royalties from Globus Medical. MP Gardner is a paid consultant and speaker for NuVasive Specialized Orthopedics and DePuy; and receives research support from Zimmer. T Kern is a paid consultant and speaker for NuVasive Specialized Orthopedics and Stryker. P Lanz is a paid consultant for NuVasive Specialized Orthopedics. SM Quinnan is a paid consultant for NuVasive Specialized Orthopedics, Biocomposites, Bone Support, Depuy, Globus Medical, Microbion, Smith & Nephew, and Stryker; and receives royalties from Globus Medical. JT Watson is a paid speaker for NuVasive Specialized Orthopedics, Smith & Nephew and Zimmer; is a paid consultant for Smith & Nephew and Bioventus; and receives royalties from Arthrex, Inc., Biomet, NuVasive Specialized Orthopedics and Smith & Nephew. JD Rölfing is a paid speaker for Orthofix, Inc. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.