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Telescopic Intramedullary Nailing

March 01, 2017

Contributors: Muharrem Inan, MD; Ilker Abdullah Sarikaya, MD; Ozan Ali Erdal, MD; Ozan Ali Erdal, MD

Telescopic intramedullary nailing is used to prevent or stabilize fractures and to correct long bone deformities in children older than 18 months who have osteogenesis imperfecta. Telescopic intramedullary nailing in combination with external fixation is indicated for long bone fracture stabilization, correction of long bone deformity, and limb lengthening in young children. Telescopic intramedullary nailing is contraindicated in children with an active infection at or near the site of osteotomy or incisions and children at the age of skeletal maturity. The telescopic intramedullary nailing system is composed of a D-profile bar with a corkscrew-shaped distal end, which is named the male part; a tube with a D-profile inner wall, which is named the female part; and a head-cap. The female part has two alternative designs, one of which is straight and one of which has 12° of proximal angulation and is specifically designed for tibial nailing. Depending on surgeon preference and the indications for the procedure, telescopic intramedullary nailing can be performed via the antegrade or retrograde technique. This video demonstrates retrograde telescopic intramedullary nailing to stabilize a mid-diaphyseal left femur fracture in a patient with osteogenesis imperfecta. The video presents the surgical technique for inserting a telescopic intramedullary nail with a corkscrew tip. Surgical steps shown include skin incision, retrograde reaming of the proximal segment, reaming of the distal segment, implantation of the telescopic intramedullary nail male part, implantation of the telescopic intramedullary nail female part, and distal locking. In our study, we evaluated the results of telescopic intramedullary nailing with a corkscrew-shaped tip in eight patients with osteogenesis imperfecta. Seventeen telescopic intramedullary nailing procedures (12 femurs and 5 tibiae) were performed in 2013 and 2014 for the management of a long bone fracture or deformity correction. The mean patient age was 82 months (approximately 7 years). The mean follow-up time was 20 months. During follow-up, all patients had complete consolidation at the fracture or osteotomy site. None of the patients experienced infection, loss of fixation, proximal or distal migration of the rods into the joints, or intraoperative fracture. Telescoping mechanisms worked well in all the patients except one, who had limited telescoping, which is defined as proximal migration of the male part with the corkscrew tip during follow-up. The patient did not require revision surgery because stability and limb alignment were maintained during follow-up. One patient underwent plate fixation of the left femur 3 months after telescopic intramedullary nailing because of nonunion and instability at the osteotomy site. Another patient experienced fracture of both femurs 6 months after telescopic intramedullary nailing. The patient was treated via exchange nailing with the use of a thicker nail.

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