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. 2018 Nov 15;26(22):e477-e482.
doi: 10.5435/JAAOS-D-17-00487.

Novel Surgical Approach to Segmental Bone Transport Using a Magnetic Intramedullary Limb Lengthening System

Gonzalo Barinaga  1 , Austin M Beason, Matthew P Gardner
Affiliations

Novel Surgical Approach to Segmental Bone Transport Using a Magnetic Intramedullary Limb Lengthening System

Gonzalo Barinaga et al. J Am Acad Orthop Surg. .

Abstract

Posttraumatic bone defects (BDs) remain a difficult complication for orthopaedic surgeons. Surgical goals in these reconstructive cases are to create stable limb fixation, maintain limb length, and provide adequate soft-tissue coverage. Historically, surgical approaches in these cases have required the use of an external fixator, which is associated with several postoperative complications. A plate-assisted bone segment transport (PABST) technique using a magnetic limb lengthening system eliminates the need for an external fixator and is effective for these reconstructive cases. A 51-year-old male patient presented as a category I trauma after a motorcycle collision. Osseous injury was defined as Gustilo-Anderson type IIIB distal tibia and fibula fracture (AO 42-C2). After fixation failure, the PABST technique was performed using a magnetic intramedullary limb lengthening system. Radiographic union was achieved 18 months postoperatively. This innovative surgical technique is effective in treating posttraumatic BDs without the need for limb shortening or the use of an external fixator. PABST has the potential to decrease postoperative complications in BD reconstructive cases using all-internal technology designed for limb lengthening. PABST, in this instance, uses a magnetic intramedullary nail that is controlled with a hand-held external remote to allow for precise, adjustable, and bidirectional bone segment transport.

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Figures

Figure 1
Figure 1
AP (A) and lateral (B) radiographs at initial injury.
Figure 2
Figure 2
A, AP radiograph showing nail fixation failure. B, Intraoperative fluoroscopic image showing residual tibial defect after fibula fixation.
Figure 3
Figure 3
AP (A) and lateral (B) radiographs of the plate-assisted bone segment transport construct with the PRECICE 2 IM nail in place.
Figure 4
Figure 4
Radiographs showing stages of healing at 3 months (A), 8 months (B), and 18 months (C), as seen on AP radiographs.
See this image and copyright information in PMC

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