Periprosthetic fracture around intramedullary magnetic femoral nail: Management and case report

Background

The intramedullary magnetic nail is an advanced technique in limb lengthening surgery, offering precise bone healing with minimal soft tissue disruption. However, increased use has led to a rise in periprosthetic fractures, and no standardized treatment protocols exist. This case report presents an innovative approach to managing such fractures without interrupting the limb lengthening process.

Case report

A 21-year-old male with a 120mm limb length discrepancy, due to childhood osteomyelitis, underwent limb lengthening surgery with an intramedullary magnetic femoral nail. Twelve days postoperatively, he sustained a periprosthetic fracture around the proximal screws of the nail following a fall. We opted to continue the lengthening therapy by securing the fracture with a proximal femoral plate using one of the nail's screws. This approach allowed uninterrupted lengthening therapy. Follow-up confirmed stable fixation and successful limb lengthening, achieving an 80mm gain and reducing the discrepancy to 40mm.

Conclusion

This case demonstrates a novel strategy for managing periprosthetic fractures during limb lengthening with intramedullary magnetic nails. By integrating the nail's proximal screw with a fixation plate, we enabled continued lengthening therapy and minimized additional surgical interventions. This approach underscores the need for further research to establish standardized protocols for managing such complications.