Mechanical Failures in Magnetic Intramedullary Lengthening Nails

Magnetic intramedullary lengthening nails (MILNs) have gained popularity in recent years for the treatment of limb-lengthening discrepancies. We sought to catalog mechanical failures and their prevention and management in a large, single-institution series. We specifically assessed the rate of mechanical failures, the types of failures observed, and management strategies.

We retrospectively reviewed 377 patients (420 limbs) who underwent limb lengthening with early (P1) or later (P2) MILN iterations with ≥12-month follow-up. Mechanical failure was defined as mechanical breakage of the instrumentation or nail and/or failure of the internal lengthening mechanism. Failure assessment was arranged by lengthening phases and was sorted with a complication classification system. All lengthening and alignment parameters were assessed radiographically.

Mechanical failure was observed in 40 nails (9.5%), most of which (63%) were corrected with an additional surgical procedure. The mechanical failure rate was 11.3% in P1 nails and 9% in P2 nails. Two nails failed the intraoperative distraction test, and 1 nail was found to have a broken washer during the insertion phase. Sixteen nails had mechanical failures in the lengthening phase. Some nails (8 of 16) required nail replacement surgery. Thirteen nails failed during the consolidation phase; 7 of these cases were managed by replacement with either a functional MILN or a conventional intramedullary nail. Eight failures happened during the extraction phase and were managed intraoperatively.

A 9.5% overall rate of mechanical failure of MILNs was observed in this large series. Resolution was achieved with an additional surgery in most cases. Nail distraction and weight-bearing compliance should be closely monitored during the lengthening and consolidation phases. Nail removal can be difficult and requires a careful study of radiographs for locking-screw bone overgrowth and backup removal equipment.

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.