Lengthening of the Femur with a Remote-Controlled Magnetic Intramedullary Nail: Retrograde Technique

JBJS Essential Surgical Techniques
Austin T Fragomen, S Robert Rozbruch

Abstract

Femoral lengthening with an intramedullary nail inserted through a retrograde approach offers the unique benefit of accurate deformity correction and distraction osteogenesis without the need for external fixation with its inherent challenges. The key to a successful deformity correction and proper nail placement is preoperative planning. Insert 2 Steinmann pins or half-pins into the proximal and distal aspects of the femur to mark any rotational deformity that is being corrected or to ensure that no rotational deformity is created. The Steinmann pins need to be ≥3 mm in diameter to prevent bending with loss of rotational reference. We prefer 5-mm or 6-mm Schanz pins for this role. These sturdy pins may be used as a "joystick" for manipulating the distal fragment to achieve a correction. This step includes the approach to and reaming of the distal fragment, which is critical to the limb alignment. Perform the percutaneous osteotomy, which allows for correction of the deformity, prior to reaming the proximal segment. While holding the distal fragment in the reduced position, prepare the proximal fragment for nail insertion. Insert the nail in a standard fashion, avoiding excessive force that could damage it or jam it into the pr...Continue Reading

References

Apr 1, 2014·Clinical Orthopaedics and Related Research·Yatin M KiraneS Robert Rozbruch
Jun 27, 2014·The Journal of the American Academy of Orthopaedic Surgeons·S Robert RozbruchJohn E Herzenberg
Jan 13, 2016·JBJS Essential Surgical Techniques·S Robert Rozbruch, Austin T Fragomen

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Citations

Oct 3, 2018·The Journal of the American Academy of Orthopaedic Surgeons·Shawn S RichardsonS Robert Rozbruch
Aug 18, 2017·The Journal of Bone and Joint Surgery. American Volume·Reggie C HamdyS Robert Rozbruch
Apr 9, 2017·International Orthopaedics·Hamza M AlrabaiJanet D Conway
Sep 13, 2017·Expert Review of Medical Devices·Austin T Fragomen, S Robert Rozbruch
Jul 10, 2018·HSS Journal : the Musculoskeletal Journal of Hospital for Special Surgery·Austin T FragomenS Robert Rozbruch
Apr 1, 2020·JBJS Reviews·Jason Shih HoellwarthMunjed Al Muderis
Jan 1, 2021·HSS Journal : the Musculoskeletal Journal of Hospital for Special Surgery·Asim M MakhdomS Robert Rozbruch
Jul 31, 2021·Strategies in Trauma and Limb Reconstruction·Aleksey DvorzhinskiyS Robert Rozbruch

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