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Magnetic intramedullary Bone Transport (PRECICE) versus Induced Membrane Technique for diaphyseal and
Laurent Desfonds1, Marion Halbaut1, Marc Saab2
1Service de Traumatologie, Hôpital Roger Salengro, CHU Lille, Rue Emile Laine 59037 Lille, France.
Background:
Traumatic segmental bone defects of the lower limb represent a major surgical challenge in trauma surgery. No reconstruction technique has demonstrated clear superiority. The PRECICE® magnetic intramedullary bone transport nail (Globus Medical®) is a recent device with limited comparative data. This study aimed to compare union rates and time to union between magnetic intramedullary bone transport and the second stage of induced membrane technique (Masquelet technique) used as the reference standard.
Hypothesis:
Magnetic intramedullary bone transport achieves higher union rates than the second stage of induced membrane technique in the management of complex diaphyseal and metaphyseal-diaphyseal traumatic bone defects of the femur and tibia.
Materials And Methods:
A single-center, multi-operator, retrospective comparative cohort study was conducted at the University Hospital of Lille between 2019 and 2024. Thirty-three patients aged between 18 to 70 years with traumatic diaphyseal or metaphyseal-diaphyseal bone defects of the femur or tibia were included. Eleven patients treated with magnetic intramedullary bone transport (8 bone nailing transport; 3 PABST: Plate Assisted Bone Segment Transport) were included with 22 with autologous bone grafting at the second stage of the induced membrane technique. The primary outcome was bone union assessed by using the RUST/mRUST score (threshold >9/12). Secondary outcomes included Time to full-weight bearing, total number of surgical procedures to bone union and time to consolidation. Multivariate analysis was adjusted for defect size.
Results:
The only statistically significant variable between the two groups was the mean bone defects size that was significantly larger in transport group (9.3 ± 4.0 cm vs 5.3 ± 3.1 cm (p = 0.005)). Bone union was achieved in 11/11 patients in transport group versus 10/22 in the induced membrane group (p = 0.002) at 24 months. After adjustment, the difference remained statistically significant (OR 24.4, 95%CI: 1.09-547.5 (p = 0.044)). After adjustment the time to full weight-bearing (4.7 ± 2.2 vs 3.5 ± 2.6 months (p = 0.20) and number of surgical procedures (4.2 ± 1.5 vs 4.0 ± 1.5 (p = 0.90)) did not differ significantly between groups. Time to consolidation (13.8 ± 5.2 vs 5.1 ± 7.0 p = 0.003) differ significantly between groups DISCUSSION: In this single-center retrospective series, magnetic intramedullary bone transport using PRECICE system achieved union in all cases including large defects without increasing the number of surgical procedures or delaying weight bearing resumption. These results support its role as a reliable alternative in the management of complex post traumatic bone of lower limb.
Level Of Evidence:
III; case matched study.