Annals of joint · 2026
Technical considerations and early results of magnetic compressive intramedullary nailing for tibial and femoral shaft non-unions: a case series.
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Cognetti Daniel J, Gutierrez-Naranjo Jose M, Ghali Abdullah, Valero-Moreno Eduardo, Hand Thomas L, Karia Ravi A
Аннотация
BACKGROUND: Non-union of femoral and tibial shaft fractures remains a challenging complication following surgical fixation. Magnetic intramedullary nails (mIMNs) allow controlled compression and distraction, offering a potential alternative to traditional exchange nailing or external fixation. However, limited clinical data exist regarding their efficacy and complications in treating long bone non-unions. This case series presents early outcomes and technical considerations of compressive magnetic intramedullary nailing for femoral and tibial shaft non-unions.
CASE DESCRIPTION: We conducted a retrospective case series at a level 1 trauma center in adult patients undergoing compressive magnetic intramedullary nailing of their femoral (n=5) or tibia (n=3) non-unions between 2017 and 2022. Eight patients were included with a mean age at surgery of 38±16 years and a mean follow-up of 16.1±8.7 months. All patients had at least one prior surgical procedure before mIMN. Five patients (62.5%) sustained initial open fractures. Six of eight patients (75%) achieved radiographic union at a mean of 6±2.6 months. Two patients did not achieve union for distinct reasons: one patient required an above-knee amputation due to deep infection, while the other, who had a persistent distal docking site non-union following bone transport with a magnetic nail, refused the recommended secondary surgery for bone grafting at the site.
CONCLUSIONS: mIMNs are a potential solution for complex tibial and femoral shaft non-unions, providing stable fixation while enabling controlled bone transport without the need for external fixation. Early results demonstrate satisfactory union rates. However, comparative studies are required to clarify optimal indications, timing of compression, and long-term outcomes.
CASE DESCRIPTION: We conducted a retrospective case series at a level 1 trauma center in adult patients undergoing compressive magnetic intramedullary nailing of their femoral (n=5) or tibia (n=3) non-unions between 2017 and 2022. Eight patients were included with a mean age at surgery of 38±16 years and a mean follow-up of 16.1±8.7 months. All patients had at least one prior surgical procedure before mIMN. Five patients (62.5%) sustained initial open fractures. Six of eight patients (75%) achieved radiographic union at a mean of 6±2.6 months. Two patients did not achieve union for distinct reasons: one patient required an above-knee amputation due to deep infection, while the other, who had a persistent distal docking site non-union following bone transport with a magnetic nail, refused the recommended secondary surgery for bone grafting at the site.
CONCLUSIONS: mIMNs are a potential solution for complex tibial and femoral shaft non-unions, providing stable fixation while enabling controlled bone transport without the need for external fixation. Early results demonstrate satisfactory union rates. However, comparative studies are required to clarify optimal indications, timing of compression, and long-term outcomes.