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Flexible Titanium Intramedullary Nail Displacement After Magnetic Resonance Imaging.

Katherine Velicki¹, Julianna Mazziotti, Connor Pihl

¹From the Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, OR.

Journal of the American Academy of Orthopaedic Surgeons. Global Research & Reviews

|September 25, 2023

Summary

Untethered titanium orthopedic implants can displace early after surgery, even when meeting standards. This case highlights a risk of proximal displacement in pediatric forearm fractures treated with flexible nails.

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Area of Science:

Orthopedic surgery
Pediatric orthopedics
Biomaterials science

Background:

Malunion of pediatric forearm fractures often requires surgical intervention.
Open reduction and internal fixation with flexible nails is a common treatment for pediatric radius and ulna fractures.
Titanium alloy nails are widely used due to their biocompatibility and strength.

Observation:

A 7-year-old boy with radius and ulna malunion underwent internal fixation with titanium alloy nails.
Postoperatively, the patient experienced elbow pain after a sedated MRI.
Radiographic evaluation revealed proximal displacement of the ulnar flexible nail by 1.5 cm.

Findings:

The untethered ulnar flexible nail displaced proximally in the early postoperative period.
Displacement occurred despite the implant meeting American Society for Testing and Materials (ASTM) standards.
This complication was noted after a sedated MRI, suggesting potential iatrogenic or spontaneous movement.

Implications:

Untethered orthopedic implants, including titanium flexible nails, carry a risk of early postoperative displacement.
Careful patient monitoring and implant selection are crucial in pediatric fracture management.
Further research may be needed to optimize fixation methods for flexible nails to prevent migration.