Disintegration of the Second-Generation Precice Bone Transport Nail During Removal Is Still an Issue: A Case Report

Intramedullary bone transport nails (BTNs) have become an increasingly common method for managing bone defects. The Precice BTN (Globus Medical, Inc.) was previously associated with mechanical failures including intramedullary disintegration during elective nail removal. These issues were reportedly resolved in the second generation BTN.

Adhering to the CARE checklist, we describe a case involving a 23-year-old male with a posttraumatic bone defect following a motorcycle accident. He sustained a Gustilo-Anderson Type IIIB comminuted right fracture with a 5 cm bone defect. The leg was initially stabilized with external fixation. After several debridements, the fracture was internally stabilized using a regular trauma nail while the soft-tissue defect was covered with a free flap and split-thickness skin grafting. Subsequently, the 5 cm bone defect was managed using a second-generation BTN. After 8 months, the patient underwent a planned nail removal according to the manufacturer's instructions. Just as with the first-generation BTN, the nail disintegrated within the medullary canal during the procedure and separated into multiple components. These internal components were cumbersomely removed using long forceps.

Mechanical failure, specifically intramedullary disintegration, still occurs with the second-generation BTN upon nail removal. The retention plug of the first-generation BTN should thus be used despite instructions from the manufacturer that the problem has been solved in the current generation BTN. Appropriate instruments to manage potential nail disintegration should be present. The case underlines the need for further design improvements in future generations of BTN.