Clinical compatibility of magnetic resonance imaging with magnetic intramedullary nails: a feasibility study.

INTRODUCTION: The use of magnetic resonance imaging (MRI) with a magnetic intramedullary lengthening nail in place is contraindicated per the manufacturer due to the concern of implant activation and migration. A prior in vitro study did not confirm these complications only noting that a 3.0 T MRI weakened the internal magnet. Therefore, a retrospective analysis of patients who underwent an MRI with a magnetic nail in place was performed to determine if any adverse effects occurred in the clinical setting. MATERIALS AND METHODS: A retrospective review of all patients who underwent an MRI with a magnetic lengthening nail in place was performed. The time spent being imaged in the MRI, number of times the patient entered the MRI suite, and the images obtained were recorded. Radiographs were performed before and after the MRI to determine if any hardware complications occurred. The patients were monitored for any adverse symptoms while they were in the suite. RESULTS: A total of 12 patients with 13 nails were identified. Two patients underwent imaging with a 3.0 T MRI while the remaining 10 underwent imaging with a 1.5 T MRI. Each patient entered the MRI suite 2.1 times and spent an average of 84.7 min being imaged in the MRI (range 21-494). No patients noted any adverse symptoms related to the nail while in the suite and no hardware complications were identified. CONCLUSION: MRI appears to be safe with a magnetic nail in place and did not result in any complications. Given the manufacturer's recommendations, informed consent should be obtained prior to an MRI being performed and a 3.0 T MRI should be avoided when possible if further activation of the nail is required.

Reconstruction of Bony Defects With Motorized Intramedullary Nails After Tumor Resection.

Motorized intramedullary lengthening nails allow for transport of a bone segment for limb lengthening, deformity correction, healing of nonunion, and intercalary distraction osteogenesis. Resection of tumors involving the bone can result in substantial defects that require reconstruction. Use of these nails allows for a biologic reconstruction with the incorporation of allograft or by distraction osteogenesis. Limb lengthening after an internal hemipelvectomy where the hip joint is resected can be performed to improve gait, decrease pain, and prevent the need for a custom shoe or shoe lift. Using these nails in compression aids the incorporation of intercalary allografts and prevents stress shielding and stress risers within the graft when compared with plating. It also allows for a subsequent lengthening of the limb using the same implant. Plate-assisted bone segment transport or the use of a bone transport nail allows for a true biologic reconstruction of an intercalary defect using distraction osteogenesis. These implants provide the orthopaedic oncologist with more options for reconstruction and the potential to improve the function and outcomes of their patients.

Role of immunotherapy in chondrosarcoma: A case report and review of the literature.

Chondrosarcomas (CSs) consist of a heterogenous group of primary bone cancers arising from malignant cells which produce cartilaginous matrix. As the second most common primary bone cancer, CS are often resistant to systemic chemotherapy due to poor vascularization, slow proliferation, and expression of multidrug-resistant pumps. Immune checkpoint inhibitors have transformed the field of oncology and are now designated as frontline therapy for many solid tumor cancers. Several studies have demonstrated increased expression of programed cell death 1 (PD-1) and PD-L1 in CS tissue in vitro, which has led to the development of multiple clinical trials for immunotherapy in patients with aggressive CS. In this review, we highlight the ongoing investigation into the role for immunotherapy in CS. We also report the case of a 44-year-old female with a history of stage IV primary CS of the right shoulder who underwent radical resection with recurrence and demonstrated a spectacular sustained response to pembrolizumab at our center. Our review highlights the need for further studies investigating the role of immunotherapy in the treatment of aggressive bone sarcomas that are resistant to standard surgical resection, chemotherapy, and radiation treatment.

Chondrosarcoma is a cancer of the cells that make cartilage and is often removed surgically. However, when the cancer spreads to other organs such as the lungs or are in areas unreachable by surgeons, there are not many effective treatments. While targeted treatments are in development, many of them have unclear effectiveness. A new and rapidly growing area of cancer treatment is known as immunotherapy, which uses the body's own immune system to kill cancer cells. In this review, we discuss trials in using immunotherapy against aggressive forms of chondrosarcoma. We also present the case of a patient where an immunotherapy agent called pembrolizumab was highly effective in preventing disease progression.

All-Internal Limb Lengthening with Simultaneous Corrective Osteotomy After Internal Hemipelvectomy: A Case Report.

CASE: A 27-year-old woman with a Grade II chondrosarcoma in the right acetabulum underwent a Type II internal hemipelvectomy with an ischiofemoral fusion. She developed a 7.0-cm functional limb-length discrepancy with adduction of the hip at rest. Four years after surgery, she underwent a corrective osteotomy and limb lengthening with a magnetic lengthening nail. Eleven years after tumor resection and a successful pregnancy, she had symmetric leg lengths and ambulated without an assistive device. CONCLUSIONS: A magnetic lengthening nail is a viable option for correcting limb-length discrepancies after hemipelvectomy. If necessary, a simultaneous corrective proximal femoral osteotomy can be performed.

Technical considerations for the management of segmental osseous defects with an internal bone transport nail.

INTRODUCTION: Traditionally, distraction osteogenesis has been accomplished with an external fixator. All internal transport utilizing magnetic intramedullary nails is a newer technique for bone reconstruction. The Precice Bone Transport Nail is a new implant that allows for noninvasive transport via a magnetically driven motor. AREAS COVERED: This report describes the function of the Bone Transport Nail along with the technical considerations on how to successfully manage bone defects with this new technology. Appropriate use of the nail, preoperative planning, intraoperative considerations, and postoperative management are discussed in detail. EXPERT OPINION: The Precice Bone Transport Nail utilizes the technology of the original Precice nail to provide an all-internal option for reconstruction of intercalary defects. This obviates the need for an additional plate with a standard Precice nail when performing bone transport and allows for a less invasive option that decreases operating room time. It provides a more cosmetic result than external fixation and avoids the risks of pin tract infection. Preoperative planning is essential to appropriate execution of the operative procedure and to perform a successful transport. A thorough understanding of the nail design and limitations are a prerequisite as this implant is significantly different from a standard intramedullary nail.

Outpatient Opioid Prescribing Habits in Pediatric Patients With Bone Sarcomas After Undergoing Primary Tumor Resection.

BACKGROUND: The majority of children with bone sarcomas experience pain. Opioids remain the mainstay treatment of cancer-related pain in children. The patterns of outpatient opioid prescription after surgery for primary bone sarcomas remains unknown. The purpose of this study is to evaluate the patterns of outpatient opioid prescription in patients with bone sarcomas after resection of the primary tumor, and to assess for factors that may lead to increased opioid dosing in these patients. METHODS: A retrospective chart review of 28 patients with bone sarcomas undergoing primary tumor resection was performed. Demographic, medical, surgical, and pharmacological data was collected from all patients. The total morphine milligram equivalents (MMEs) prescribed after patient discharge were compared at 30-day intervals. The MMEs were then stratified by tumor location, presence of metastasis at time of surgery, and preoperative opioid use. Independent predictors of increased 30-day and total 120-day opioid utilization were evaluated. RESULTS: Patients with preoperative opioid use were prescribed significantly more opioids in every 30-day postoperative interval and for the 120-day total. When stratified by tumor location, patients with primary tumors in the pelvis had significantly greater postoperative opioid utilization when compared with patients with tumors located in the lower and upper extremities during postoperative days 61 to 90 (5970 vs. 1060.4 and 0 MMEs, respectively, P=0.048) and during postoperative days 91 to 120 (6450 vs. 829.6 and 0 MMEs, respectively, P=0.015). Older age, diagnosis of osteosarcoma, increased length of stay postoperatively and presence of metastases were associated with a higher 30-day postoperative opioid utilization. CONCLUSION: Multiple factors were associated with increased opioid use including preoperative opioid use, longer postoperative stay in the hospital, metastatic disease, and primary sarcomas in the pelvis. The patient's sex, body mass index, race, type of insurance, type of surgery performed, reoperation during the same admission and use of nonopioid adjuvants had no effect on opioid use. The results of this study can be used to stratify the average opioid requirement of pediatric patients undergoing primary bone sarcoma resection. LEVEL OF EVIDENCE: Level IV.

Comparison of forces generated using compression plating versus a magnetic lengthening nail in a sawbones femur model.

BACKGROUND: The purpose of this study is to compare compression generated by a Precice magnetic lengthening intramedullary nail and a 5.0 mm limited contact dynamic compression plate. METHODS: Transverse osteotomy sites were created in the femoral shaft of ten Sawbones fourth generation composite femurs. Antegrade 10-degree trochanteric Precice nails and 8-hole, 5.0 mm plates were used for fixation. The plates were compressed by placing a neutral screw and three eccentrically drilled compression screws on alternating sides of the osteotomy. Average compression and distribution of compression were compared, and P-values <0.05 were considered statistically significant. FINDINGS: The Precice nail generated an average of 2.38 megapascal across the osteotomy sites. The plate generated an average of 0.70 megapascal (P < 0.001) with the initial compression screw, 0.93 megapascal (P < 0.001) after the second screw, and 1.04 megapascal (p < 0.001) after the final screw. The distribution of compression was assessed utilizing a polar transformation to compare pressure values. We found that the distribution of compression was more circumferentially uniform in the Precice nail group (P = 0.046). INTERPRETATION: This study demonstrates that an electromagnetic intramedullary device is capable of generating significantly higher compression, in a more uniform distribution, than a 5.0 mm limited contact dynamic compression plate in a Sawbones model. The results indicate that electromagnetic intramedullary nail systems may be an ideal alternative to compression plating for treatment of at-risk fractures, nonunions, delayed unions, and intercalary allograft reconstruction.

Biologic Reconstruction With a Motorized Intramedullary Bone Transport Nail After Tumor Resection.

SUMMARY: Distraction osteogenesis is an option for reconstruction of intercalary defects. The use of bone transport after tumor surgery has been limited because of concerns of pin tract infections with external fixation and the theoretical risk of causing tumor growth. The effects of chemotherapy and radiation on the regenerate and healing of the docking site are also not well studied, but the current literature has mostly favorable outcomes with no evidence of causing tumor proliferation. The Precice bone transport nail offers a noninvasive method of distraction osteogenesis, which eliminates the need for prolonged external fixation and the risk of pin tract infections. This report discusses the technique for using the Precice bone transport nail after tumor resection. Bone transport may be considered for intercalary defects after en bloc resection of sarcoma, metastatic disease, and benign aggressive bone tumors. The use of distraction osteogenesis after tumor resection is a promising technique for the biologic reconstruction of intercalary defects.

Unusual presentation in Haiti of a recurrent giant cell tumor of bone affecting the distal radius: A case report.

INTRODUCTION: Giant cell tumor of bone (GCTB) is a benign-aggressive tumor that has a high-rate of recurrence with curettage resection alone. Patients with GCTB in underserved regions of the world can have progression of the tumor with significant disability due to a lack of specialty care. We present a case of an en bloc resection of an aggressive, recurrent GCTB of the radius with excellent function and no evidence of tumor recurrence two years after surgery. PRESENTATION OF CASE: A 22-year-old right-hand dominant female in Haiti developed an aggressive recurrence of a giant cell tumor of bone (GCTB) of the distal radius. Treatment consisted of en bloc resection of the distal radius with the proximal row of the carpus and centralization of the ulna. At two-year follow-up, the patient maintained good functional capacity with no clinical or radiological evidence of recurrence. DISCUSSION: GCTB can cause significant destruction of the bone and articular surface if not treated adequately. Treatment options should be considered carefully in underserved regions of the world based on the resources available. This case exemplifies that complex limb-salvage surgery is possible when coordination of care between international and local surgeons is provided with an emphasis on continuity of care post-operatively. CONCLUSION: En bloc resection with centralization of the ulna remains a viable technique to address aggressive GCTB of the distal radius and can be appropriate in resource-limited settings.

Ultrasound-Assisted Posterior Knee Arthroscopy: A Description of the Technique.

Entering the posterior knee with arthroscopy can be difficult. Scar tissue, a tumor, and the obese patient can make instrument placement difficult and risk iatrogenic injury. Ultrasound can be used to visualize the posterior knee and provide direct guidance of instrumentation. We describe the technique and indications for using ultrasound during arthroscopy. Accurate and atraumatic insertion of instruments can be performed with no damage to total knee components or the knee joint. Ultrasound guidance should be considered during difficult posterior knee arthroscopy.

Bupivacaine and Lidocaine Induce Apoptosis in Osteosarcoma Tumor Cells.

BACKGROUND: Osteosarcoma is the most common type of bone cancer in adolescents. There have been no significant improvements in outcomes since chemotherapy was first introduced. Bupivacaine and lidocaine have been shown to be toxic to certain malignancies. This study evaluates the effect of these medications on two osteosarcoma cell lines. QUESTIONS/PURPOSES: (1) Does incubation of osteosarcoma cells with bupivacaine or lidocaine result in cell death? (2) Does this result from an apoptotic mechanism? (3) Is a specific apoptotic pathway implicated? METHODS: Two cell lines were chosen to account for the inherent heterogeneity of osteosarcoma. UMR-108 is a transplantable cell line that has been used in multiple studies as a primary tumor. MNNG/HOS has a high metastatic rate in vivo. Both cell lines were exposed bupivacaine (0.27, 0.54, 1.08, 2.16, 4.33 and 8.66 mM) and lidocaine (0.66, 1.33, 5.33, 10.66, 21.32 and 42.64 mM) for 24 hours, 48 hours, and 72 hours. These concentrations were determined by preliminary experiments that found the median effective dose was 1.4 mM for bupivacaine and 7.0 mM for lidocaine in both cell lines. Microculture tetrazolium and colony formation assay determined whether cell death occurred. Apoptosis induction was evaluated by phase-contrast micrographs, flow cytometry, DNA fragmentation and reactive oxygen species (ROS). The underlying pathways were analyzed by protein electrophoresis and Western blot. All testing was performed in triplicate and compared with pH-adjusted controls. Quantitative results were analyzed without blinding. RESULTS: Both medications caused cell death in a dose- and time-dependent manner. Exposure to bupivacaine for 24 hours reduced viability of UMR-108 cells by 6 ± 0.75% (95% CI 2.9 to 9.11; p = 0.01) at 1.08 mM and 89.67 ± 1.5% (95% CI 82.2 to 95.5; p < 0.001) at 2.16 mM. Under the same conditions, MNNG/HOS viability was decreased in a similar fashion. After 24 hours, the viability of UMR-108 and MNNG/HOS cells exposed to 5.33 mM of lidocaine decreased by 25.33 ± 8.3% (95% CI 2.1 to 48.49; p = 0.03) and 39.33 ± 3.19% (95% CI 30.46 to 48.21; p < 0.001), respectively, and by 90.67 ± 0.66% (95% CI 88.82 to 92.52; p < 0.001) and 81.6 ± 0.47% (95% CI 79.69 to 82.31; p < 0.001) at 10.66 mM, respectively. After 72 hours, the viability of both cell lines was further reduced. Cell death was consistent with apoptosis based on cell morphology, total number of apoptotic cells and DNA fragmentation. The percentage increase of apoptotic UMR-108 and MNNG/HOS cells confirmed by Annexin-V positivity compared with controls was 21.3 ± 2.82 (95% CI 16.25 to 26.48; p < 0.001) and 21.23 ± 3.23% (95% CI 12.2 to 30.2; p = 0.003) for bupivacaine at 1.08 mM and 25.15 ± 4.38 (95% CI 12.9 to 37.3; p = 0.004) and 9.11 ± 1.74 (95% CI 4.35 to 13.87; p = 0.006) for lidocaine at 5.33 mM. The intrinsic apoptotic pathway was involved as the expression of Bcl-2 and survivin were down-regulated, and Bax, cleaved caspase-3 and cleaved poly (ADP-ribose) polymerase-1 were increased. ROS production increased in the UMR-108 cells but was decreased in the MNNG/HOS cells. CONCLUSION: These findings provide a basis for evaluating these medications in the in vivo setting. Studies should be performed in small animals to determine if clinically relevant doses have a similar effect in vivo. In humans, biopsies could be performed with standard doses of these medications to see if there is a difference in biopsy tract contamination on definitive resection. CLINICAL RELEVANCE: Bupivacaine and lidocaine could potentially be used for their ability to induce and enhance apoptosis in local osteosarcoma treatment. Outcome data when these medications are used routinely during osteosarcoma treatment can be evaluated compared with controls. Further small animal studies should be performed to determine if injection into the tumor, isolated limb perfusion, or other modalities of treatment are viable.

Secondary Chondrosarcoma Arising from the Proximal Fibula Presenting as Sciatica.

INTRODUCTION: Secondary chondrosarcoma is a rare entity arising from a pre-existing cartilaginous lesion. Transformation of an osteochondroma to a chondrosarcoma occurs in <1% of cases. Sciatica is a common problem that can cause significant pain, weakness, and numbness. CASE REPORT: A 36-year-old male presented to the Orthopedic Oncology Service after being treated for sciatica for 3 years. Magnetic resonance imaging of the lumbar spine demonstrated degenerative disc disease with mild inferior foraminal narrowing at L5-S1. He had undergone multiple epidural steroid injections without improvement in his symptoms. A chondrosarcoma encasing the peroneal nerve was found arising from an underlying osteochondroma in the proximal fibula. The patient underwent resection of the tumor which included resection of the peroneal nerve. Five years after resection, the patient is disease free and uses an ankle-foot orthosis for ambulation. CONCLUSION: This case demonstrates the importance of evaluating a patient with peripheral nerve symptoms for a lesion within the involved extremity along the entire length of the nerve. Extraspinal lesions can compress peripheral nerves and cause radicular symptoms. Timely treatment is important to prevent malignant transformation or worsening of the tumor as well as to provide better functional outcome.

Antiproliferative effect of bupivacaine on patient-derived sarcoma cells.

Sarcomas are rare tumors with limited treatment options. Although chemotherapy is standard for certain subtypes, overall survival has not improved in several decades. Bupivacaine has been shown to induce apoptosis and prevent cell growth in multiple different types of malignancies but has not been studied in sarcoma. The current study evaluated the effects of bupivacaine on multiple patient-derived sarcoma cells and a commercial sarcoma cell line. Multiple patient-derived sarcoma cell subtypes and a commercial synovial cell sarcoma cell line were exposed to bupivacaine for different durations and at different concentrations. The patient-derived cells included a high-grade conventional osteosarcoma, a high-grade undifferentiated pleomorphic sarcoma of bone, and a high-grade synovial sarcoma. Flow cytometry and an MTT assay were used to evaluate whether a treatment effect was observed. Treatment of all the subtypes of sarcomas in this study with bupivacaine demonstrated a time- and dose-dependent increase in apoptosis and decrease in cell viability. A cell viability assay demonstrated that the IC50 was between 0.04 and 0.05% and that the treatment effect occurred at clinically relevant doses in vitro. Bupivacaine was toxic to both the patient-derived cells and the commercial cell line at doses commonly used in the clinical setting. These findings provide a foundation for further in vivo studies to evaluate whether these effects will translate to the clinical setting. Although further research is necessary, bupivacaine shows promise as not only an adjunct for pain management but as a treatment modality for sarcoma.

Successful treatment of a dedifferentiated chondrosarcoma of the proximal humerus with a hemicortical articular surface sparing allograft: A case report.

INTRODUCTION: Dedifferentiated chondrosarcomas are rare and highly malignant tumors that require wide surgical resection. Survival is extremely poor without adequate surgical margins. We present a case of articular sparing surgery of the shoulder for dedifferentiated chondrosarcoma with excellent functional outcomes and no evidence of disease after fifty-six months. PRESENTATION OF CASE: A 29-year-old male was found to have a non-metastatic right proximal humerus dedifferentiated chondrosarcoma. He underwent resection with clear one centimeter margins sparing the medial cortex and the articular surface. Reconstruction of the bone was accomplished using a hemicortical allograft. A dermal allograft was used to help reconstruct the rotator cuff to the allograft bone. At fifty-six months after surgery he has excellent functional range of motion. His current MSTS, Quick Dash, and Constant Shoulder scores are 29, 2.3, and 80, respectively. He has remained free of disease, is back to work without restrictions and is active in outdoor activities. DISCUSSION: Dedifferentiated chondrosarcoma has high recurrence and poor survival rates. Adequate surgical resection is vital for its treatment. Previously described reconstructive techniques have consisted of articular replacement with a prosthesis, allograft, or allograft-prosthetic composites. To our knowledge, this is the first report of an articular sparing reconstruction for dedifferentiated chondrosarcoma with fifty-six month survival and functional outcomes. When possible, sparing the articular surface can provide good functional outcomes that improve over time. CONCLUSION: If adequate surgical margins can be obtained, an articular surface sparing reconstruction of the shoulder can provide effective functional outcomes and an alternative to joint replacement.

Limb Salvage for Musculoskeletal Tumors in the Austere Environment: Review of the Literature With Illustrative Cases Regarding Considerations and Pitfalls.

Although there is literature discussing the treatment of acute and chronic trauma in austere environments, no literature or guidelines for the treatment of musculoskeletal tumors exist. This series discusses case examples with considerations and pitfalls of performing limb-salvage surgery in an underserved location. Cases of limb-salvage surgery performed by the same orthopaedic oncologist in Haiti and the Dominican Republic are discussed with a review of the literature on limb salvage for musculoskeletal tumors in developing nations. All patients successfully underwent limb-salvage surgery after considering multiple factors including tumor type and location. Patients with metastatic disease, likelihood of substantial blood loss, and poor health were not candidates for limb-salvage surgery. Medical missions and the development of partnerships with established training programs make limb salvage a greater possibility. Knowledge of the facility, anesthesia support, and instrumentation available is vital. Advanced imaging, blood products, and allograft are likely unavailable or difficult to obtain. Established continuity of care is necessary, and training of the local surgeon should be provided. Surgery should only be considered if it is safe and provides more of a benefit to the patient than an amputation.

Inhibitory Effects of Indomethacin in Human MNNG/HOS Osteosarcoma Cell Line In Vitro.

Recurrence or metastasis remains the major cause of poor prognosis and mortality in Osteosarcoma patients. Therefore, development of more effective therapeutic approaches is required. We showed that indomethacin, significantly induces apoptosis in MNNG/HOS cell line, which was confirmed by morphological changes, increased Annexin-V + cells and nuclear fragmentation. Apoptosis was accompanied by increased cleavage of caspase-3 and PARP, suggesting activation of caspase-dependent cell death. Indomethacin significantly decreased the expression of ß-catenin, a key player in tumor metastasis. These results indicate that indomethacin may have the potential to be used as neoadjuvant or adjuvant treatment; however, additional studies are required.

Short tau inversion recovery magnetic resonance imaging for staging and screening in myxoid liposarcoma.

PURPOSE: Myxoid liposarcoma has a propensity to metastasize to bone. MRI is the preferred modality for detecting bone disease. We evaluated multiple MRI sequences to determine an optimal screening method. METHODS: Whole body MRI was performed on all patients. The number and locations of metastases found by imaging and round cell component of the sites sampled were evaluated. RESULTS: We found a total of 68 osseous lesions. Whole body MRI utilizing STIR only sequences decreased imaging time by 83.6% and demonstrated the lesions the best. CONCLUSIONS: STIR sequences can be exclusively used during staging and screening of myxoid liposarcoma.

Development of multifocal extra-abdominal desmoid fibromatosis after surgical resection.

Multifocal fibromatosis is a rare entity. We report on two cases where multifocal disease developed after surgical resection. Chronic inflammation and repetitive trauma may be considered a risk factor for developing multifocal disease.

The In Vitro Effects of Bupivacaine on Cartilage-forming Tumor Cells.

INTRODUCTION: Bupivacaine is a commonly used local anesthetic that has been shown to be cytotoxic to articular chondrocytes and various tumor cells. This study evaluates the in vitro effects of bupivacaine on cartilaginous tumor cells. METHODS: Multiple different cartilaginous tumors were evaluated, including enchondromas, chondroblastomas, a low-grade chondrosarcoma, which were harvested from patients during tumor resection, and a grade-II chondrosarcoma SW1535 (ATCC HTB-94). The tumor cells were treated with 0.25% and 0.5% bupivacaine at various times points, and the result was compared with that of untreated tumor cells. Tumor cell viability and apoptosis were evaluated by MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide) assay and flow cytometry. RESULTS: The tumors were analyzed in groups according to their pathologic diagnosis. Increasing periods of exposure to bupivacaine decreased the cell viability in all tumor samples. The cytotoxicity of 0.5% bupivacaine was significantly greater than that of 0.25% bupivacaine in all tumor cells tested. DISCUSSION: At clinically relevant concentrations, in vitro exposure to bupivacaine caused a decrease in cellular viability and an increase in the induction of apoptosis in a dose- and time-dependent manner in each of the tumor cells evaluated in this study.

Use of Magnetic Growing Intramedullary Nails in Compression During Intercalary Allograft Reconstruction.

Traditionally, intercalary allograft reconstruction after tumor resection has had a high rate of complications, particularly nonunion. Plate and intramedullary nail fixation have been used alone and in combination to improve union rates. This study sought to evaluate a new technique that uses a magnetic growing intramedullary nail to compress the osteotomy sites to aid in healing and to answer 2 questions: (1) What is the union rate and the time to union when using magnetic growing intramedullary nails? (2) What complications occur with this technique? Eight patients with 15 osteotomy sites with a minimum follow-up of 14 months were retrospectively reviewed. Seven of the 8 patients underwent initial reconstruction with the magnetic nail, whereas 1 patient underwent treatment of a nonunion that occurred with prior carbon fiber nail fixation. Twelve of the 15 osteotomy sites had healed by an average of 9 months. Nonunions occurred in 2 patients with an associated failure of the hardware. One of these patients healed after revision surgery. Of the patients who healed at both sites, 1 had a fracture through the allograft, 1 had backing out of a locking screw that required removal, and 1 required a manipulation under anesthesia of the knee. Two patients underwent successful limb lengthening needed because of an expected limb-length discrepancy after healing occurred. Use of growing intramedullary nails in compression mode led to an 87% union rate at final follow-up with acceptable complications. This technique provides a viable alternative to standard nail and plate fixation when intercalary allografts are used. [Orthopedics. 2018; 41(6):330-335.].