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Humerus Lengthening With the PRECICE Internal Lengthening Nail
Anton M Kurtz1, S Robert Rozbruch
1*MaineOrtho, Portland, ME †The Limb Lengthening and Complex Reconstruction Service, Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY.
Insights
This study reports the first use of a motorized intramedullary nail for humeral lengthening in a pediatric patient with significant arm shortening. The technique successfully corrected limb length discrepancy while preserving shoulder and elbow function.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Limb reconstruction
Background:
- Proximal humerus growth disturbance can cause substantial upper limb-length discrepancy in children.
- Previous limb lengthening utilized external fixation devices.
- Intramedullary implants had not been reported for humeral lengthening.
Observation:
- A 15-year-old female with post-treatment unicameral bone cyst humeral shortening underwent osteoplasty and lengthening.
- A fully implantable motorized intramedullary nail was used off-label for gradual humeral lengthening.
- A varus deformity and lateral entry point facilitated the procedure, avoiding rotator cuff injury.
Findings:
- Achieved 5 cm of humeral lengthening in 9 weeks.
- Bony union occurred at 7 months, with hardware removal at 9.5 months.
- Maintained shoulder and elbow range of motion throughout treatment and post-operatively.
Implications:
- Demonstrates the feasibility of using motorized intramedullary nails for pediatric humeral lengthening.
- Offers a potential alternative to external fixation for correcting limb-length discrepancies.
- Highlights the need for further investigation into technical limitations and long-term outcomes.
Background:
Deformity and growth arrest of the humerus in children may result as sequelae of proximal humerus fractures and unicameral bone cysts, or as complications of their treatment. As approximately 80% of the growth of the humerus arises from the proximal physis, the resultant upper limb-length discrepancy can be substantial. Benefits to lengthening the shortened arm have been previously demonstrated with the use of external fixation devices. To our knowledge, no reports have been published on the use of intramedullary implants for this purpose.
Methods:
A 15-year-old girl with humeral shortening secondary to proximal humeral growth disturbance following treatment for a unicameral bone cyst was treated with humeral osteoplasty and gradual lengthening with an off-label use of a fully implantable motorized intramedullary lengthening nail. A varus proximal humeral deformity and lateral starting point allowed for avoidance of the rotator cuff insertion.
Results:
Humeral lengthening (5 cm) was achieved at 9 weeks, with bony union at 7 months, and hardware removal at 9½ months. Shoulder and elbow motion was maintained during and after treatment.
Conclusions:
This is the first case report of humeral lengthening using a fully implantable motorized intramedullary lengthening nail. Although some technical limitations remain when compared with other methods, the procedure was well tolerated throughout the course of treatment.
Level Of Evidence:
Level IV-case report.
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