Research progress of intramedullary lengthening nail technology_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Jin ¹ ,  ZHANG Yonghong ¹ , WANG Chaoqi ¹ , QIN Sihe ²

1. Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan Shanxi, 030001, P.R.China;
2. Department of Orthopaedics, Rehabilitation Hospital of the National Research Center for Rehabilitation Technical Aids, Beijing, 100176, P.R.China;

Corresponding author：

ZHANG Yonghong, Email: yhzhy@139.com

Keywords：

Intramedullary lengthening nail; limb lengthening; distraction histogenesis

DOI：

10.7507/1002-1892.202012084

Video：

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Objective To review the research progress of intramedullary lengthening nail technology.Methods The foreign literature on the development history, types, advantages and disadvantages, indications and contraindications, complications, and effectiveness of intramedullary lengthening nail were reviewed and analyzed.Results The intramedullary lengthening nail system mainly includes mechanical type, electric motor drive type, and magnetic drive type. Compared with traditional external fixation and lengthening technology, the intramedullary lengthening nail technology has certain advantages in incidence of complications, bone healing, postoperative functional rehabilitation, incision aesthetics, convenience, and patient satisfaction. However, there are also shortcomings, such as pain, uncontrollable distraction rate, device failure, etc. In the clinical application of intramedullary lengthening nails for limb lengthening, the indications should be grasped reasonably, and the related complications should be prevented and treated.Conclusion Intramedullary lengthening nails provide a new option for limb lengthening, and the initial effectiveness is good. It is one of the development direction of limb lengthening technology.

Citation： ZHANG Jin, ZHANG Yonghong, WANG Chaoqi, QIN Sihe. Research progress of intramedullary lengthening nail technology. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(5): 642-647. doi: 10.7507/1002-1892.202012084 Copy

1.	Paley D. Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop Relat Res, 1990, (250): 81-104.
2.	Luke DL, Schoenecker PL, Blair VP, et al. Fractures after Wagner limb lengthening. J Pediatr Orthop, 1992, 12(1): 20-24.
3.	Herzenberg JE, Scheufele LL, Paley D, et al. Knee range of motion in isolated femoral lengthening. Clin Orthop Relat Res, 1994, (301): 49-54.
4.	Noonan KJ, Leyes M, Forriol F, et al. Distraction osteogenesis of the lower extremity with use of monolateral external fixation. A study of two hundred and sixty-one femora and tibiae. J Bone Joint Surg (Am), 1998, 80(6): 793-806.
5.	Eldridge JC, Bell DF. Problems with substantial limb lengthening. Orthop Clin North Am, 1991, 22(4): 625-631.
6.	Pettine KA, Chao EY, Kelly PJ. Analysis of the external fixator pin-bone interface. Clin Orthop Relat Res, 1993, (293): 18-27.
7.	Ilizarov GA. The principles of the Ilizarov method. Bull Hosp Jt Dis Orthop Inst, 1988, 48(1): 1-11.
8.	Ilizarov GA, Frankel VH. The Ilizarov External Fixator, a physiologic method of orthopaedic reconstruction and skeletal correction. A conversation with Prof. G. A. Ilizarov and Victor H. Frankel. Orthop Rev, 1988, 17(11): 1142-1154.
9.	Young N, Bell DF, Anthony A. Pediatric pain patterns during Ilizarov treatment of limb length discrepancy and angular deformity. J Pediatr Orthop, 1994, 14(3): 352-357.
10.	García-Cimbrelo E, Olsen B, Ruiz-Yagüe M, et al. Ilizarov technique. Results and difficulties. Clin Orthop Relat Res, 1992, (283): 116-123.
11.	Bost FC, Larsen LJ. Experiences with lengthening of the femur over n intramedullary rod. J Bone Joint Surg (Am), 1956, 38-A(3): 567-584.
12.	Baumann F, Harms J. The extension nail. A new method for lengthening of the femur and tibia (author’s transl). Arch Orthop Unfallchir, 1977, 90(2): 139-146.
13.	Bliskunov AI. Lengthening of the femur using implantable appliances. Acta Chir Orthop Traumatol Cech, 1984, 51(6): 454-466.
14.	Witt AN, Jäger M, Bruns H, et al. An implantable femur distractor for operative leg lengthening (author’s transl). Arch Orthop Trauma Surg, 1978, 92(4): 291-296.
15.	Rozbruch SR, Birch JG, Dahl MT, et al. Motorized intramedullary nail for management of limb-length discrepancy and deformity. J Am Acad Orthop Surg, 2014, 22(7): 403-409.
16.	Aquerreta JD, Forriol F, Cañadell J. Complications of bone lengthening. Int Orthop, 1994, 18(5): 299-303.
17.	Cole JD, Justin D, Kasparis T, et al. The intramedullary skeletal kinetic distractor (ISKD): first clinical results of a new intramedullary nail for lengthening of the femur and tibia. Injury, 2001, 32 Suppl 4: SD129-139.
18.	Song HR, Oh CW, Mattoo R, et al. Femoral lengthening over an intramedullary nail using the external fixator: risk of infection and knee problems in 22 patients with a follow-up of 2 years or more. Acta Orthop, 2005, 76(2): 245-252.
19.	Guichet JM, Deromedis B, Donnan LT, et al. Gradual femoral lengthening with the Albizzia intramedullary nail. J Bone Joint Surg (Am), 2003, 85(5): 838-848.
20.	Guichet JM, Spivak JM, Trouilloud P, et al. Lower limb-length discrepancy. An epidemiologic study. Clin Orthop Relat Res, 1991, (272): 235-241.
21.	Baumgart R, Betz A, Schweiberer L. A fully implantable motorized intramedullary nail for limb lengthening and bone transport. Clin Orthop Relat Res, 1997, (343): 135-143.
22.	Burghardt RD, Paley D, Specht SC, et al. The effect on mechanical axis deviation of femoral lengthening with an intramedullary telescopic nail. J Bone Joint Surg (Br), 2012, 94(9): 1241-1245.
23.	Kenawey M, Krettek C, Liodakis E, et al. Insufficient bone regenerate after intramedullary femoral lengthening: risk factors and classification system. Clin Orthop Relat Res, 2011, 469(1): 264-273.
24.	Thaller PH, Fürmetz J, Wolf F, et al. Limb lengthening with fully implantable magnetically actuated mechanical nails (PHENIX(^®))-preliminary results. Injury, 2014, 45 Suppl 1: S60-65.
25.	Paley D. PRECICE intramedullary limb lengthening system. Expert Rev Med Devices, 2015, 12(3): 231-249.
26.	Leidinger B, Winkelmann W, Roedl R. Limb lengthening with a fully implantable mechanical distraction intramedullary nail. Z Orthop Ihre Grenzgeb, 2006, 144(4): 419-426.
27.	Konofaos P, Kashyap A, Neel MD, et al. A novel device for long bone osteodistraction: description of device and case series. Plast Reconstr Surg, 2012, 130(3): 418e-422e.
28.	Simpson AH, Shalaby H, Keenan G. Femoral lengthening with the Intramedullary Skeletal Kinetic Distractor. J Bone Joint Surg (Br), 2009, 91(7): 955-961.
29.	Schiedel FM, Pip S, Wacker S, et al. Intramedullary limb lengthening with the Intramedullary Skeletal Kinetic Distractor in the lower limb. J Bone Joint Surg (Br), 2011, 93(6): 788-792.
30.	Lee DH, Ryu KJ, Song HR, et al. Complications of the Intramedullary Skeletal Kinetic Distractor (ISKD) in distraction osteogenesis. Clin Orthop Relat Res, 2014, 472(12): 3852-3859.
31.	Makhdom AM, Cartaleanu AS, Rendon JS, et al. The accordion maneuver: A noninvasive strategy for absent or delayed callus formation in cases of limb lengthening. Adv Orthop, 2015, 2015: 912790.
32.	Singh S, Lahiri A, Iqbal M. The results of limb lengthening by callus distraction using an extending intramedullary nail (Fitbone) in non-traumatic disorders. J Bone Joint Surg (Br), 2006, 88(7): 938-942.
33.	Krieg AH, Speth BM, Foster BK. Leg lengthening with a motorized nail in adolescents: an alternative to external fixators? Clin Orthop Relat Res, 2008, 466(1): 189-197.
34.	Hrutkay JM, Eilert RE. Operative lengthening of the lower extremity and associated psychological aspects: the Children’s Hospital experience. J Pediatr Orthop, 1990, 10(3): 373-377.
35.	Calder PR, Laubscher M, Goodier WD. The role of the intramedullary implant in limb lengthening. Injury, 2017, 48 Suppl 1: S52-S58.
36.	Kirane YM, Fragomen AT, Rozbruch SR. Precision of the PRECICE internal bone lengthening nail. Clin Orthop Relat Res, 2014, 472(12): 3869-3878.
37.	Schiedel FM, Vogt B, Tretow HL, et al. How precise is the PRECICE compared to the ISKD in intramedullary limb lengthening? Reliability and safety in 26 procedures Acta Orthop, 2014, 85(3): 293-298.
38.	石博文, 舒衡生. 置入式肢体延长髓内钉的研究进展. 中华骨科杂志, 2019, 39(1): 58-64.
39.	Dahl MT. Motorized, telescopic, intramedullary lengthening nails for limb length and deformity correction. Techniques in Orthopaedics, 2015, 30(3): 189-206.
40.	Couto A, Freitas J, Alegrete N, et al. Two consecutive limb lengthenings with the same PRECICE nail: a technical note. Strategies Trauma Limb Reconstr, 2018, 13(3): 199-204.
41.	García-Cimbrelo E, Curto de la Mano A, García-Rey E, et al. The intramedullary elongation nail for femoral lengthening. J Bone Joint Surg (Br), 2002, 84(7): 971-977.
42.	Krieg AH, Lenze U, Speth BM, et al. Intramedullary leg lengthening with a motorized nail. Acta Orthop, 2011, 82(3): 344-350.
43.	Wang K, Edwards E. Intramedullary skeletal kinetic distractor in the treatment of leg length discrepancy—a review of 16 cases and analysis of complications. J Orthop Trauma, 2012, 26(9): e138-144.
44.	Burghardt RD, Herzenberg JE, Specht SC, et al. Mechanical failure of the intramedullary skeletal kinetic distractor in limb lengthening. J Bone Joint Surg (Br), 2011, 93(5): 639-643.
45.	Accadbled F, Pailhé R, Cavaignac E, et al. Bone lengthening using the Fitbone(^®) motorized intramedullary nail: The first experience in France. Orthop Traumatol Surg Res, 2016, 102(2): 217-222.
46.	Baumgart R, Thaller P, Hinterwimmer S, et al. A fully implantable, programmable distraction nail (Fitbone)—new perspectives for corrective and reconstructive limb surgery. Berlin Heidelberg: Springer, 2006: 189-198.
47.	Mazeau P, Assi C, Louahem D, et al. Complications of Albizzia femoral lengthening nail: an analysis of 36 cases. J Pediatr Orthop B, 2012, 21(5): 394-399.
48.	Kenawey M, Krettek C, Liodakis E, et al. Leg lengthening using intramedullay skeletal kinetic distractor: results of 57 consecutive applications. Injury, 2011, 42(2): 150-155.
49.	Küçükkaya M, Karakoyun Ö, Sökücü S, et al. Femoral lengthening and deformity correction using the Fitbone motorized lengthening nail. J Orthop Sci, 2015, 20(1): 149-154.
50.	Laubscher M, Mitchell C, Timms A, et al. Outcomes following femoral lengthening: An initial comparison of the Precice intramedullary lengthening nail and the LRS external fixator monorail system. Bone Joint J, 2016, 98-B(10): 1382-1388.

1. Paley D. Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop Relat Res, 1990, (250): 81-104.
2. Luke DL, Schoenecker PL, Blair VP, et al. Fractures after Wagner limb lengthening. J Pediatr Orthop, 1992, 12(1): 20-24.
3. Herzenberg JE, Scheufele LL, Paley D, et al. Knee range of motion in isolated femoral lengthening. Clin Orthop Relat Res, 1994, (301): 49-54.
4. Noonan KJ, Leyes M, Forriol F, et al. Distraction osteogenesis of the lower extremity with use of monolateral external fixation. A study of two hundred and sixty-one femora and tibiae. J Bone Joint Surg (Am), 1998, 80(6): 793-806.
5. Eldridge JC, Bell DF. Problems with substantial limb lengthening. Orthop Clin North Am, 1991, 22(4): 625-631.
6. Pettine KA, Chao EY, Kelly PJ. Analysis of the external fixator pin-bone interface. Clin Orthop Relat Res, 1993, (293): 18-27.
7. Ilizarov GA. The principles of the Ilizarov method. Bull Hosp Jt Dis Orthop Inst, 1988, 48(1): 1-11.
8. Ilizarov GA, Frankel VH. The Ilizarov External Fixator, a physiologic method of orthopaedic reconstruction and skeletal correction. A conversation with Prof. G. A. Ilizarov and Victor H. Frankel. Orthop Rev, 1988, 17(11): 1142-1154.
9. Young N, Bell DF, Anthony A. Pediatric pain patterns during Ilizarov treatment of limb length discrepancy and angular deformity. J Pediatr Orthop, 1994, 14(3): 352-357.
10. García-Cimbrelo E, Olsen B, Ruiz-Yagüe M, et al. Ilizarov technique. Results and difficulties. Clin Orthop Relat Res, 1992, (283): 116-123.
11. Bost FC, Larsen LJ. Experiences with lengthening of the femur over n intramedullary rod. J Bone Joint Surg (Am), 1956, 38-A(3): 567-584.
12. Baumann F, Harms J. The extension nail. A new method for lengthening of the femur and tibia (author’s transl). Arch Orthop Unfallchir, 1977, 90(2): 139-146.
13. Bliskunov AI. Lengthening of the femur using implantable appliances. Acta Chir Orthop Traumatol Cech, 1984, 51(6): 454-466.
14. Witt AN, Jäger M, Bruns H, et al. An implantable femur distractor for operative leg lengthening (author’s transl). Arch Orthop Trauma Surg, 1978, 92(4): 291-296.
15. Rozbruch SR, Birch JG, Dahl MT, et al. Motorized intramedullary nail for management of limb-length discrepancy and deformity. J Am Acad Orthop Surg, 2014, 22(7): 403-409.
16. Aquerreta JD, Forriol F, Cañadell J. Complications of bone lengthening. Int Orthop, 1994, 18(5): 299-303.
17. Cole JD, Justin D, Kasparis T, et al. The intramedullary skeletal kinetic distractor (ISKD): first clinical results of a new intramedullary nail for lengthening of the femur and tibia. Injury, 2001, 32 Suppl 4: SD129-139.
18. Song HR, Oh CW, Mattoo R, et al. Femoral lengthening over an intramedullary nail using the external fixator: risk of infection and knee problems in 22 patients with a follow-up of 2 years or more. Acta Orthop, 2005, 76(2): 245-252.
19. Guichet JM, Deromedis B, Donnan LT, et al. Gradual femoral lengthening with the Albizzia intramedullary nail. J Bone Joint Surg (Am), 2003, 85(5): 838-848.
20. Guichet JM, Spivak JM, Trouilloud P, et al. Lower limb-length discrepancy. An epidemiologic study. Clin Orthop Relat Res, 1991, (272): 235-241.
21. Baumgart R, Betz A, Schweiberer L. A fully implantable motorized intramedullary nail for limb lengthening and bone transport. Clin Orthop Relat Res, 1997, (343): 135-143.
22. Burghardt RD, Paley D, Specht SC, et al. The effect on mechanical axis deviation of femoral lengthening with an intramedullary telescopic nail. J Bone Joint Surg (Br), 2012, 94(9): 1241-1245.
23. Kenawey M, Krettek C, Liodakis E, et al. Insufficient bone regenerate after intramedullary femoral lengthening: risk factors and classification system. Clin Orthop Relat Res, 2011, 469(1): 264-273.
24. Thaller PH, Fürmetz J, Wolf F, et al. Limb lengthening with fully implantable magnetically actuated mechanical nails (PHENIX(^®))-preliminary results. Injury, 2014, 45 Suppl 1: S60-65.
25. Paley D. PRECICE intramedullary limb lengthening system. Expert Rev Med Devices, 2015, 12(3): 231-249.
26. Leidinger B, Winkelmann W, Roedl R. Limb lengthening with a fully implantable mechanical distraction intramedullary nail. Z Orthop Ihre Grenzgeb, 2006, 144(4): 419-426.
27. Konofaos P, Kashyap A, Neel MD, et al. A novel device for long bone osteodistraction: description of device and case series. Plast Reconstr Surg, 2012, 130(3): 418e-422e.
28. Simpson AH, Shalaby H, Keenan G. Femoral lengthening with the Intramedullary Skeletal Kinetic Distractor. J Bone Joint Surg (Br), 2009, 91(7): 955-961.
29. Schiedel FM, Pip S, Wacker S, et al. Intramedullary limb lengthening with the Intramedullary Skeletal Kinetic Distractor in the lower limb. J Bone Joint Surg (Br), 2011, 93(6): 788-792.
30. Lee DH, Ryu KJ, Song HR, et al. Complications of the Intramedullary Skeletal Kinetic Distractor (ISKD) in distraction osteogenesis. Clin Orthop Relat Res, 2014, 472(12): 3852-3859.
31. Makhdom AM, Cartaleanu AS, Rendon JS, et al. The accordion maneuver: A noninvasive strategy for absent or delayed callus formation in cases of limb lengthening. Adv Orthop, 2015, 2015: 912790.
32. Singh S, Lahiri A, Iqbal M. The results of limb lengthening by callus distraction using an extending intramedullary nail (Fitbone) in non-traumatic disorders. J Bone Joint Surg (Br), 2006, 88(7): 938-942.
33. Krieg AH, Speth BM, Foster BK. Leg lengthening with a motorized nail in adolescents: an alternative to external fixators? Clin Orthop Relat Res, 2008, 466(1): 189-197.
34. Hrutkay JM, Eilert RE. Operative lengthening of the lower extremity and associated psychological aspects: the Children’s Hospital experience. J Pediatr Orthop, 1990, 10(3): 373-377.
35. Calder PR, Laubscher M, Goodier WD. The role of the intramedullary implant in limb lengthening. Injury, 2017, 48 Suppl 1: S52-S58.
36. Kirane YM, Fragomen AT, Rozbruch SR. Precision of the PRECICE internal bone lengthening nail. Clin Orthop Relat Res, 2014, 472(12): 3869-3878.
37. Schiedel FM, Vogt B, Tretow HL, et al. How precise is the PRECICE compared to the ISKD in intramedullary limb lengthening? Reliability and safety in 26 procedures Acta Orthop, 2014, 85(3): 293-298.
38. 石博文, 舒衡生. 置入式肢体延长髓内钉的研究进展. 中华骨科杂志, 2019, 39(1): 58-64.
39. Dahl MT. Motorized, telescopic, intramedullary lengthening nails for limb length and deformity correction. Techniques in Orthopaedics, 2015, 30(3): 189-206.
40. Couto A, Freitas J, Alegrete N, et al. Two consecutive limb lengthenings with the same PRECICE nail: a technical note. Strategies Trauma Limb Reconstr, 2018, 13(3): 199-204.
41. García-Cimbrelo E, Curto de la Mano A, García-Rey E, et al. The intramedullary elongation nail for femoral lengthening. J Bone Joint Surg (Br), 2002, 84(7): 971-977.
42. Krieg AH, Lenze U, Speth BM, et al. Intramedullary leg lengthening with a motorized nail. Acta Orthop, 2011, 82(3): 344-350.
43. Wang K, Edwards E. Intramedullary skeletal kinetic distractor in the treatment of leg length discrepancy—a review of 16 cases and analysis of complications. J Orthop Trauma, 2012, 26(9): e138-144.
44. Burghardt RD, Herzenberg JE, Specht SC, et al. Mechanical failure of the intramedullary skeletal kinetic distractor in limb lengthening. J Bone Joint Surg (Br), 2011, 93(5): 639-643.
45. Accadbled F, Pailhé R, Cavaignac E, et al. Bone lengthening using the Fitbone(^®) motorized intramedullary nail: The first experience in France. Orthop Traumatol Surg Res, 2016, 102(2): 217-222.
46. Baumgart R, Thaller P, Hinterwimmer S, et al. A fully implantable, programmable distraction nail (Fitbone)—new perspectives for corrective and reconstructive limb surgery. Berlin Heidelberg: Springer, 2006: 189-198.
47. Mazeau P, Assi C, Louahem D, et al. Complications of Albizzia femoral lengthening nail: an analysis of 36 cases. J Pediatr Orthop B, 2012, 21(5): 394-399.
48. Kenawey M, Krettek C, Liodakis E, et al. Leg lengthening using intramedullay skeletal kinetic distractor: results of 57 consecutive applications. Injury, 2011, 42(2): 150-155.
49. Küçükkaya M, Karakoyun Ö, Sökücü S, et al. Femoral lengthening and deformity correction using the Fitbone motorized lengthening nail. J Orthop Sci, 2015, 20(1): 149-154.
50. Laubscher M, Mitchell C, Timms A, et al. Outcomes following femoral lengthening: An initial comparison of the Precice intramedullary lengthening nail and the LRS external fixator monorail system. Bone Joint J, 2016, 98-B(10): 1382-1388.

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