Progress of remote-control intramedullary lengthening nail and its clinical treatment concept_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Fuhuan ¹ , Peter H. Thaller ¹ ,  QIN Sihe ²

1. 3D-Surgery, Department of General-, Trauma-, and Reconstructive Surgery, University Hospital of Munich (LMU), Munich, 80336, Germany;
2. Department of Orthopaedic Surgery, Rehabilitation Hospital of the National Research Center for Rehabilitation Technical Aids, Beijing, 100176, P.R.China;

Corresponding author：

QIN Sihe, Email: qinsihe@163.com

Keywords：

Remote-control intramedullary lengthening nail; limb orthopedics; Ilizarov’s technology; treatment concept

DOI：

10.7507/1002-1892.202107012

Video：

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Ilizarov’s technology is an internationally recognized clinical treatment method for limb orthopedics, but there are many complications related to external fixation. With the development and progress of the times, the remote-control intramedullary lengthening nails had risen to prominence on the international stage as the second generation of orthomelic technology based on Ilizarov’s technology. Since the first remote-control intramedullary lengthening nail appeared in the 1980s, after more than 40 years of development, there are currently more than 3 types of extension mechanisms in remote-control intramedullary lengthening nails and a mature and stable clinical treatment model has been formed during the past long-term clinical treatment and experiments, such as the End-Point-First (EPF) program proposed by Professor Peter H. Thaller in Germany. Compared with Ilizarov’s technology, the remote-control intramedullary lengthening nail has obvious advantages in convenience, comfort, risk of infection, soft tissue injury, postoperative pain, and controllability of limb lengthening. This article mainly introduces the development and clinical treatment concept of remote-control intramedullary lengthening nail and the latest clinical treatment status of limb lengthening therapy abroad, hoping to provide new cognition and ideas for the further development of limb orthopedics in China.

Citation： CHEN Fuhuan, Peter H. Thaller, QIN Sihe. Progress of remote-control intramedullary lengthening nail and its clinical treatment concept. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(12): 1623-1629. doi: 10.7507/1002-1892.202107012 Copy

1.	Ilizarov GA. The tension-stress effect on the genesis and growth of tissues: Part Ⅱ. The influence of the rate and frequency of distraction. Clin Orthop Relat Res, 1989, (239): 263-285.
2.	Jauregui JJ, Bor N, Thakral R, et al. Life- and limb-threatening infections following the use of an external fixator. Bone Joint J, 2015, 97-B(9): 1296-1300.
3.	秦泗河. 中国矫形外科发展70年. 中华创伤杂志, 2019, 35(9): 790-795.
4.	Eralp L, Kocaoglu M, Yusof NM, et al. Distal tibial reconstruction with use of a circular external fixator and an intramedullary nail. The combined technique. J Bone Joint Surg (Am), 2007, 89(10): 2218-2224.
5.	Mahboubian S, Seah M, Fragomen AT, et al. Femoral lengthening with lengthening over a nail has fewer complications than intramedullary skeletal kinetic distraction. Clin Orthop Relat Res, 2012, 470(4): 1221-1231.
6.	Götz J, Schellmann WD. Continuous lengthening of the femur with intramedullary stabilisation (author’s transl). Arch Orthop Unfallchir, 1975, 82(4): 305-310.
7.	Panagiotopoulou VC, Davda K, Hothi HS, et al. A retrieval analysis of the Precice intramedullary limb lengthening system. Bone Joint Res, 2018, 7(7): 476-484.
8.	Barakat AH, Sayani J, O’Dowd-Booth C, et al. Lengthening nails for distraction osteogenesis: a review of current practice and presentation of extended indications. Strategies Trauma Limb Reconstr, 2020, 15(1): 54-61.
9.	Hankemeier S, Pape HC, Gosling T, et al. Improved comfort in lower limb lengthening with the intramedullary skeletal kinetic distractor. Principles and preliminary clinical experiences. Arch Orthop Trauma Surg, 2004, 124(2): 129-133.
10.	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.
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.	Brunner U, Kessler S, Cordey J, et al. Treatment of defects of the long bones using distraction osteogenesis (Ilizarov) and intramedullary nailing. Theoretic principles, animal experiments, clinical relevance. Unfallchirurg, 1990, 93(6): 244-250.
13.	Schellmann WD. Principles of intramedullary osteosynthesis. Hefte Unfallheilkd, 1977, (129): 48-56.
14.	Bliskunov AI. Intramedullary distraction of the femur (preliminary report). Ortop Travmatol Protez, 1983, (10): 59-62.
15.	Weber P, Hax PM, Betz A. Ausgleich posttraumatischer Beinlängendifferenzen mit einem Verlängerungsmarknagel. Trauma Berufskrankh, 2017, 19: 191-197.
16.	Lecoanet P, Legallois Y, Ribes C, et al. Medium-term evaluation of leg lengthening by ISKD^® intramedullary nail in 28 patients: Should we still use this lengthening system? Orthop Traumatol Surg Res, 2020, 106(7): 1433-1440.
17.	Betz A, Baumgart R, Schweiberer L. 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(8): 605-609.
18.	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.
19.	Dinçyürek H, Kocaoğlu M, Eralp IL, et al. Functional results of lower extremity lengthening by motorized intramedullary nails. Acta Orthop Traumatol Turc, 2012, 46(1): 42-49.
20.	Black SR, Kwon MS, Cherkashin AM, et al. Lengthening in congenital femoral deficiency: A comparison of circular external fixation and a motorized intramedullary nail. J Bone Joint Surg (Am), 2015, 97(17): 1432-1440.
21.	Paley D. PRECICE intramedullary limb lengthening system. Expert Rev Med Devices, 2015, 12(3): 231-249.
22.	RozbruchSR, Hamdy RC. Limb lengthening and reconstruction surgery case atlas. Switzerland: Springer International Publishing, 2015: 27-31.
23.	Paley D, Harris M, Debiparshad K, et al. Limb lengthening by implantable limb lengthening devices. Tech Orthop, 2014, 29: 72. doi: 10.1097/BTO.0000000000000072.
24.	Thaller PH, Degen N, Fürmetz J, et al. Längen-, Achs- und Torsionskorrekturen mit distraktionsmarknägeln: erfahrungen mit 5 verschiedenen systemen. Trauma Berufskrankh, 2017, 19: 182-190.
25.	Gomez-Alessandri J, Sanpera-Iglesias J, Raluy-Collado D, et al. Maximizing length with precice nail: a novel technique. J Pediatr Orthop B, 2020. doi: 10.1097/BPB.0000000000000822.
26.	Galal S, Shin J, Principe P, et al. STRYDE versus PRECICE magnetic internal lengthening nail for femur lengthening. Arch Orthop Trauma Surg, 2021. doi: 10.1007/s00402-021-03943-8.
27.	Thaller PH, Wolf F, Kucukkaya M. Surgical techniques for lengthening and deformity correction of the tibia with lengthening nails. Techniques in Orthopaedics, 2014, 29: 150-157.
28.	Thaller PH, Wolf F. Retrograde femur technique for motorized internal limb lengthening. Techniques in Orthopaedics, 2020, 35: 171-175.
29.	Liantis P, Mavrogenis AF, Stavropoulos NA, et al. Risk factors for and complications of distraction osteogenesis. Eur J Orthop Surg Traumatol, 2014, 24(5): 693-698.
30.	Summers S, Krkovic M. Bone transport with magnetic intramedullary nails in long bone defects. Eur J Orthop Surg Traumatol, 2021, 31(6): 1243-1252.
31.	Fürmetz J, Kold S, Schuster N, et al. Lengthening of the humerus with intramedullary lengthening nails-preliminary report. Strategies Trauma Limb Reconstr, 2017, 12(2): 99-106.

1. Ilizarov GA. The tension-stress effect on the genesis and growth of tissues: Part Ⅱ. The influence of the rate and frequency of distraction. Clin Orthop Relat Res, 1989, (239): 263-285.
2. Jauregui JJ, Bor N, Thakral R, et al. Life- and limb-threatening infections following the use of an external fixator. Bone Joint J, 2015, 97-B(9): 1296-1300.
3. 秦泗河. 中国矫形外科发展70年. 中华创伤杂志, 2019, 35(9): 790-795.
4. Eralp L, Kocaoglu M, Yusof NM, et al. Distal tibial reconstruction with use of a circular external fixator and an intramedullary nail. The combined technique. J Bone Joint Surg (Am), 2007, 89(10): 2218-2224.
5. Mahboubian S, Seah M, Fragomen AT, et al. Femoral lengthening with lengthening over a nail has fewer complications than intramedullary skeletal kinetic distraction. Clin Orthop Relat Res, 2012, 470(4): 1221-1231.
6. Götz J, Schellmann WD. Continuous lengthening of the femur with intramedullary stabilisation (author’s transl). Arch Orthop Unfallchir, 1975, 82(4): 305-310.
7. Panagiotopoulou VC, Davda K, Hothi HS, et al. A retrieval analysis of the Precice intramedullary limb lengthening system. Bone Joint Res, 2018, 7(7): 476-484.
8. Barakat AH, Sayani J, O’Dowd-Booth C, et al. Lengthening nails for distraction osteogenesis: a review of current practice and presentation of extended indications. Strategies Trauma Limb Reconstr, 2020, 15(1): 54-61.
9. Hankemeier S, Pape HC, Gosling T, et al. Improved comfort in lower limb lengthening with the intramedullary skeletal kinetic distractor. Principles and preliminary clinical experiences. Arch Orthop Trauma Surg, 2004, 124(2): 129-133.
10. 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.
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. Brunner U, Kessler S, Cordey J, et al. Treatment of defects of the long bones using distraction osteogenesis (Ilizarov) and intramedullary nailing. Theoretic principles, animal experiments, clinical relevance. Unfallchirurg, 1990, 93(6): 244-250.
13. Schellmann WD. Principles of intramedullary osteosynthesis. Hefte Unfallheilkd, 1977, (129): 48-56.
14. Bliskunov AI. Intramedullary distraction of the femur (preliminary report). Ortop Travmatol Protez, 1983, (10): 59-62.
15. Weber P, Hax PM, Betz A. Ausgleich posttraumatischer Beinlängendifferenzen mit einem Verlängerungsmarknagel. Trauma Berufskrankh, 2017, 19: 191-197.
16. Lecoanet P, Legallois Y, Ribes C, et al. Medium-term evaluation of leg lengthening by ISKD^® intramedullary nail in 28 patients: Should we still use this lengthening system? Orthop Traumatol Surg Res, 2020, 106(7): 1433-1440.
17. Betz A, Baumgart R, Schweiberer L. 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(8): 605-609.
18. 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.
19. Dinçyürek H, Kocaoğlu M, Eralp IL, et al. Functional results of lower extremity lengthening by motorized intramedullary nails. Acta Orthop Traumatol Turc, 2012, 46(1): 42-49.
20. Black SR, Kwon MS, Cherkashin AM, et al. Lengthening in congenital femoral deficiency: A comparison of circular external fixation and a motorized intramedullary nail. J Bone Joint Surg (Am), 2015, 97(17): 1432-1440.
21. Paley D. PRECICE intramedullary limb lengthening system. Expert Rev Med Devices, 2015, 12(3): 231-249.
22. RozbruchSR, Hamdy RC. Limb lengthening and reconstruction surgery case atlas. Switzerland: Springer International Publishing, 2015: 27-31.
23. Paley D, Harris M, Debiparshad K, et al. Limb lengthening by implantable limb lengthening devices. Tech Orthop, 2014, 29: 72. doi: 10.1097/BTO.0000000000000072.
24. Thaller PH, Degen N, Fürmetz J, et al. Längen-, Achs- und Torsionskorrekturen mit distraktionsmarknägeln: erfahrungen mit 5 verschiedenen systemen. Trauma Berufskrankh, 2017, 19: 182-190.
25. Gomez-Alessandri J, Sanpera-Iglesias J, Raluy-Collado D, et al. Maximizing length with precice nail: a novel technique. J Pediatr Orthop B, 2020. doi: 10.1097/BPB.0000000000000822.
26. Galal S, Shin J, Principe P, et al. STRYDE versus PRECICE magnetic internal lengthening nail for femur lengthening. Arch Orthop Trauma Surg, 2021. doi: 10.1007/s00402-021-03943-8.
27. Thaller PH, Wolf F, Kucukkaya M. Surgical techniques for lengthening and deformity correction of the tibia with lengthening nails. Techniques in Orthopaedics, 2014, 29: 150-157.
28. Thaller PH, Wolf F. Retrograde femur technique for motorized internal limb lengthening. Techniques in Orthopaedics, 2020, 35: 171-175.
29. Liantis P, Mavrogenis AF, Stavropoulos NA, et al. Risk factors for and complications of distraction osteogenesis. Eur J Orthop Surg Traumatol, 2014, 24(5): 693-698.
30. Summers S, Krkovic M. Bone transport with magnetic intramedullary nails in long bone defects. Eur J Orthop Surg Traumatol, 2021, 31(6): 1243-1252.
31. Fürmetz J, Kold S, Schuster N, et al. Lengthening of the humerus with intramedullary lengthening nails-preliminary report. Strategies Trauma Limb Reconstr, 2017, 12(2): 99-106.

Chinese Journal of Reparative and Reconstructive Surgery

Progress of remote-control intramedullary lengthening nail and its clinical treatment concept

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