Extraction of a Broken PRECICE Bone Transport System: A Case Report and Technique for Residual Limb Salvage

To describe a surgical technique for the safe removal of a broken non-cannulated PRECICE bone transport nail (NuVasive Specialized Orthopedics) without compromising limb reconstruction.

The removal of broken non-cannulated intramedullary lengthening nails (IMLNs) is challenging. Few techniques have been described for the safe removal of these devices without compromising bone salvage.

A 42-year-old male presented for complex right tibia reconstruction following a type IIIB open tibia fracture with a 92-mm bone defect. The bone defect was initially managed with an all-internal bone transport nail system (PRECICE bone transport). At the 13-month follow-up, the patient presented with a broken lengthening nail, varus limb deformity, and nonunion at the docking site. The nail components were extracted sequentially, and a burr hole was created in the distal segment of the nail through the nonunion site to facilitate removal. The residual varus deformity and tibial shaft nonunion were managed with a hexapod frame.

The IMLN was successfully removed without compromising limb reconstruction. By sequentially removing the components of the nail and altering the distal portion of the implant through the nonunion site, safe removal of the implant without further bone loss was achieved.

This report describes an efficient technique for the removal of broken non-cannulated IMLNs when extractors are not available.

Legler J, Martel S, Mailhot P, et al. Extraction of a Broken PRECICE Bone Transport System: A Case Report and Technique for Residual Limb Salvage. Strategies Trauma Limb Reconstr 2024;19(3):171-176.