Use of the PRECICE nail for distraction osteogenesis after tumor resection

ABSTRACT

Introduction

Reconstructing long bone defects following intercalary tumor resection presents an exciting challenge with a greater range of surgical solutions than more typical situations requiring arthroplasty. Segmental bone transport (distraction osteogenesis) is the least utilized option for intercalary reconstruction; however, it arguably provides patients with the most desirable result. Distraction osteogenesis can be used in the management of multiple skeletal conditions including deformity (congenital or acquired), or in the presence of bone defects (by trauma or planned surgical excision). Lack of broader adoption of transport is likely due to the highly technical demands and common complications of utilizing fine-wire fixators via the Ilizarov method. More recently, internal lengthening nails such as the PRECICE nail have been employed to facilitate distraction osteogenesis without the added complexity of external fixation.

Areas covered

This review will examine the literature on the indications, design, and safety of the PRECICE nail (NuVasive) for intercalary reconstruction after tumor resection.

Expert opinion

Bone transport using the PRECICE nail represents a viable alternative to Ilizarov distraction and has the benefit of avoiding the complications of an external fixator. For large defects, the PRECICE nail can be supplemented with a locking plate for additional stability and maintenance of limb length.

KEYWORDS:

• Intercalary defects
• PRECICE nails
• limb lengthening
• distraction osteosynthesis
• intramedullary nail
• plate-assisted distraction osteosynthesis

Article highlights

• The PRECICE nail is an electromagnetically actuated intramedullary nail that allows activation with an external remote controller

• The specific technique for bone transport using PRECICE is based on the size of the defect as well as anatomic considerations

• The PRECICE nail may be used independently for small defects or be augmented with a locking plate for large segmental defects to maintain limb length and increase axial and rotational stability

• Advantages of the PRECICE nail for bone transport versus traditional external fixators include a theoretically lower risk of infection, all-inside construct, and potentially fewer operations

• Further larger cohort–control studies examining the efficacy of the PRECICE nail are needed prior to recommending it as a superior option to external fixators for bone transport in tumor patients

Declaration of interest

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewers disclosure

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

Additional information

Funding

This paper was not funded.