Different types of external fixators have been used for humeral lengthening with successful outcomes reported in literature. Motorized intramedullary (IM) lengthening nails have been developed as an alternative to external fixators for long bone lengthening in the lower extremity.
This case series reports on using the new technology of IM lengthening nails for humeral lengthening. We assessed the radiological healing and functional outcomes after using the PRECICE IM nail for humeral lengthening.
This multicenter retrospective study included a total of six humeri in five patients (mean age was 20 years) that underwent lengthening with the magnetic IM PRECICE nail in two centers in the USA. The etiology was humeral growth arrest post-bone cyst (two segments), post-septic growth arrest (two segments), and multiple hereditary exostosis (bilateral segments in one patient). The outcomes measured were the length achieved, distraction index (DI; the length achieved in mm divided by the duration of lengthening in days), consolidation index (CI; number of days from surgery until consolidation divided by the length of the regenerate in cm), complications encountered, and functional outcomes (shoulder and elbow range of motion, the upper extremity functional index (UEFI), and QuickDASH functional scores).
The mean follow-up period was 1.8 years (0.9 to 2.4 years). All segments achieved the goal of lengthening; the mean was 5.1 cm (4.5 to 5.8 cm). Mean DI was 0.7 mm/day (0.5 to 0.8). Mean CI was 36 days/cm (25 to 45 days/cm). No complications were observed. At the last follow-up, all patients maintained their preoperative range of motion (ROM) except one patient had reduced shoulder ROM. QuickDASH score and upper extremity functional index showed postoperative improvement compared to the preoperative scores.
IM lengthening nails can provide successful and safe humeral lengthening. Specifically, the PRECICE nail has accurate control over the lengthening process.
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Conflict of Interest
Ahmed I. Hammouda, MD, has declared that he has no conflict of interest. Shawn C. Standard, MD, reports grants from NuVasive Specialized Orthopedics, during the conduct of the study; personal fees from NuVasive Specialized Orthopedics and Pega Medical; grants from CS Medical Supply, Metro Prosthetics, and Stryker; grants from Baxter, DePuy Synthes, Merete Technologies, MHE Coalition, NuVasive Specialized Orthopedics, Orthofix, OrthoPediatrics, Smith & Nephew, Stryker, and Zimmer Biomet, outside the work. S. Robert Rozbruch, MD, reports personal fees from Smith and Nephew, Stryker, NuVasive, outside the work. John E. Herzenberg, MD reports grants from NuVasive Specialized Orthopedics, during the conduct of the study; personal fees from Orthofix; grants from OrthoPediatrics, NuVasive Specialized Orthopedics, Smith & Nephew, CS Medical Supply, Metro Prosthetics, and Stryker, Baxter, DePuy Synthes, Merete Technologies, MHE Coalition, NuVasive Specialized Orthopedics, Orthofix, OrthoPediatrics, Smith & Nephew, Stryker, and Zimmer Biomet, outside the work.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).
Informed consent was obtained from all patients for being included in the study.
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Level of Evidence: Level IV
Study performed at Sinai Hospital of Baltimore, Baltimore, MD, USA, and Hospital for Special Surgery, New York, NY, USA.
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Hammouda, A.I., Standard, S.C., Robert Rozbruch, S. et al. Humeral Lengthening with the PRECICE Magnetic Lengthening Nail. HSS Jrnl 13, 217–223 (2017). https://doi.org/10.1007/s11420-017-9552-x
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