Systematic review of complications with externally controlled motorized intramedullary bone lengthening nails (FITBONE and PRECICE) in 983 segments

Abstract

Background and purpose — In recent years motorized
intramedullary lengthening nails have become increasingly
popular. Complications are heterogeneously reported in
small case series and therefore we made a systematic review
of complications occurring in lower limb lengthening with
externally controlled motorized intramedullary bone lengthening
nails.

Methods — We performed a systematic search in
PubMed, EMBASE, and the Cochrane Library with medical
subject headings: Bone Nails, Bone Lengthening, and PRECICE
and FITBONE nails. Complications were graded on
severity and origin.

Results — The search identified 952 articles; 116 were
full text screened, and 41 were included in the final analysis.
983 segments were lengthened in 782 patients (age 8–74
years). The distribution of nails was: 214 FITBONE, 747
PRECICE, 22 either FITBONE or PRECICE. Indications for
lengthening were: 208 congenital shortening, 305 acquired
limb shortening, 111 short stature, 158 with unidentified etiology.
We identified 332 complications (34% of segments):
Type I (minimal intervention) in 11% of segments; Type II
(substantial change in treatment plan) in 15% of segments;
Type IIIA (failure to achieve goal) in 5% of segments; and
Type IIIB (new pathology or permanent sequelae) in 3% of
segments. Device and bone complications were the most frequent.

Interpretation — The overall risk of complications was 1
complication for every 3 segments lengthened. In 1 of every
4 segments, complications had a major impact leading to
substantial change in treatment, failure to achieve lengthening
goal, introduction of a new pathology, or permanent
sequelae. However, as no standardized reporting method for
complications exists, the true complication rates might be
different.