{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:46:44Z","timestamp":1787755604076,"version":"build-2784847793"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,1,18]]},"abstract":"\n Background:<\/jats:title>\n Magnetic intramedullary lengthening nails (MILNs) have gained popularity in recent years for the treatment of limb-lengthening discrepancies. We sought to catalog mechanical failures and their prevention and management in a large, single-institution series. We specifically assessed the rate of mechanical failures, the types of failures observed, and management strategies.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n We retrospectively reviewed 377 patients (420 limbs) who underwent limb lengthening with early (P1) or later (P2) MILN iterations with \u226512-month follow-up. Mechanical failure was defined as mechanical breakage of the instrumentation or nail and\/or failure of the internal lengthening mechanism. Failure assessment was arranged by lengthening phases and was sorted with a complication classification system. All lengthening and alignment parameters were assessed radiographically.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n Mechanical failure was observed in 40 nails (9.5%), most of which (63%) were corrected with an additional surgical procedure. The mechanical failure rate was 11.3% in P1 nails and 9% in P2 nails. Two nails failed the intraoperative distraction test, and 1 nail was found to have a broken washer during the insertion phase. Sixteen nails had mechanical failures in the lengthening phase. Some nails (8 of 16) required nail replacement surgery. Thirteen nails failed during the consolidation phase; 7 of these cases were managed by replacement with either a functional MILN or a conventional intramedullary nail. Eight failures happened during the extraction phase and were managed intraoperatively.<\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n A 9.5% overall rate of mechanical failure of MILNs was observed in this large series. Resolution was achieved with an additional surgery in most cases. Nail distraction and weight-bearing compliance should be closely monitored during the lengthening and consolidation phases. Nail removal can be difficult and requires a careful study of radiographs for locking-screw bone overgrowth and backup removal equipment.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence:<\/jats:title>\n \n Therapeutic\n Level IV<\/jats:underline>\n . See Instructions for Authors for a complete description of levels of evidence.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.2106\/jbjs.22.00283","type":"journal-article","created":{"date-parts":[[2023,1,18]],"date-time":"2023-01-18T11:00:26Z","timestamp":1674039626000},"page":"113-127","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":18,"title":["Mechanical Failures in Magnetic Intramedullary Lengthening Nails"],"prefix":"10.2106","volume":"105","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0315-1827","authenticated-orcid":false,"given":"Larysa P.","family":"Hlukha","sequence":"first","affiliation":[{"name":"International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7486-1087","authenticated-orcid":false,"given":"Hamza M.","family":"Alrabai","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, King Saud University, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver C.","family":"Sax","sequence":"additional","affiliation":[{"name":"International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3811-4818","authenticated-orcid":false,"given":"Ahmed I.","family":"Hammouda","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Al-Azhar University, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4379-7622","authenticated-orcid":false,"given":"Philip K.","family":"McClure","sequence":"additional","affiliation":[{"name":"International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6650-9251","authenticated-orcid":false,"given":"John E.","family":"Herzenberg","sequence":"additional","affiliation":[{"name":"International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,12,15]]},"reference":[{"issue":"3","key":"bib1-20250430","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1097\/BTO.0000000000000145","article-title":"Motorized, telescopic, intramedullary lengthening nails for limb length and deformity correction","volume":"30","author":"Dahl","year":"2015","journal-title":"Techniques in Orthopaedics."},{"issue":"Suppl 4","key":"bib2-20250430","doi-asserted-by":"crossref","first-page":"SD129","DOI":"10.1016\/S0020-1383(01)00116-4","article-title":"The Intramedullary Skeletal Kinetic Distractor (ISKD): first clinical results of a new intramedullary nail for lengthening of the femur and tibia","volume":"32","author":"Cole","year":"2001","journal-title":"Injury."},{"issue":"7","key":"bib3-20250430","doi-asserted-by":"crossref","first-page":"403","DOI":"10.5435\/JAAOS-22-07-403","article-title":"Motorized intramedullary nail for management of limb-length discrepancy and deformity","volume":"22","author":"Rozbruch","year":"2014","journal-title":"Journal of the American Academy of Orthopaedic Surgeons."},{"issue":"2","key":"bib4-20250430","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1097\/BTO.0000000000000072","article-title":"Limb lengthening by implantable limb lengthening devices","volume":"29","author":"Paley","year":"2014","journal-title":"Techniques in Orthopaedics."},{"issue":"17","key":"bib5-20250430","first-page":"1432","article-title":"Lengthening in congenital femoral deficiency: a comparison of circular external fixation and a motorized intramedullary nail","volume":"97","author":"Black","year":"2015","journal-title":"The Journal of Bone and Joint Surgery-American Volume."},{"issue":"3","key":"bib6-20250430","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1586\/17434440.2015.1005604","article-title":"PRECICE intramedullary limb lengthening system","volume":"12","author":"Paley","year":"2015","journal-title":"Expert Review of Medical Devices."},{"issue":"5","key":"bib7-20250430","first-page":"639","article-title":"Mechanical failure of the Intramedullary Skeletal Kinetic Distractor in limb lengthening","volume":"93-B","author":"Burghardt","year":"2011","journal-title":"The Journal of Bone and Joint Surgery. British volume."},{"issue":"2","key":"bib8-20250430","doi-asserted-by":"crossref","first-page":"110","DOI":"10.5005\/jp-journals-10080-1529","article-title":"Complications in elective removal of 271 bone lengthening nails (FITBONE, PRECICE and STRYDE)","volume":"16","author":"Rahbek","year":"2021","journal-title":"Strategies in Trauma and Limb Reconstruction."},{"issue":"1","key":"bib9-20250430","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1080\/17453674.2020.1835321","article-title":"Systematic review of complications with externally controlled motorized intramedullary bone lengthening nails (FITBONE and PRECICE) in 983 segments","volume":"92","author":"Frost","year":"2021","journal-title":"Acta Orthopaedica."},{"issue":"2","key":"bib10-20250430","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1097\/BPB.0000000000000138","article-title":"Evaluation of complications of treatment of severe Blount\u2019s disease by circular external fixation using a novel classification scheme","volume":"24","author":"Cherkashin","year":"2015","journal-title":"Journal of Pediatric Orthopaedics B."},{"issue":"10","key":"bib11-20250430","doi-asserted-by":"crossref","first-page":"2069","DOI":"10.1016\/j.injury.2015.07.033","article-title":"Unusual complication with an intramedullary lengthening device 15 months after implantation","volume":"46","author":"Tiefenb\u00f6ck","year":"2015","journal-title":"Injury."},{"issue":"3","key":"bib12-20250430","doi-asserted-by":"crossref","first-page":"293","DOI":"10.3109\/17453674.2014.913955","article-title":"How precise is the PRECICE compared to the ISKD in intramedullary limb lengthening? Reliability and safety in 26 procedures","volume":"85","author":"Schiedel","year":"2014","journal-title":"Acta Orthopaedica."},{"issue":"19","key":"bib13-20250430","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1051\/sicotj\/2016048","article-title":"PRECICE\u00ae magnetically-driven, telescopic, intramedullary lengthening nail: pre-clinical testing and first 30 patients","volume":"3","author":"Wagner","year":"2017","journal-title":"SICOT J."},{"issue":"11","key":"bib14-20250430","doi-asserted-by":"crossref","first-page":"3350","DOI":"10.1016\/j.injury.2021.09.006","article-title":"Implant failure after externally magnetic-controlled nail lengthening","volume":"52","author":"Rentenberger","year":"2021","journal-title":"Injury."},{"issue":"3","key":"bib15-20250430","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1097\/BTO.0000000000000140","article-title":"Stature lengthening using the PRECICE intramedullary lengthening nail","volume":"30","author":"Paley","year":"2015","journal-title":"Techniques in Orthopaedics."},{"issue":"4","key":"bib16-20250430","doi-asserted-by":"crossref","first-page":"e36273","DOI":"10.5812\/atr.36273","article-title":"Limb Lengthening Using the PRECICETM Nail System: Complications and Results","volume":"5","author":"Wiebking","year":"2016","journal-title":"Arch Trauma Res."},{"issue":"7","key":"bib17-20250430","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1016\/j.injury.2018.05.005","article-title":"Recommendation of use of checklists in tibial intramedullary nail removal: retrospective study of mechanical complications related to nail removal","volume":"49","author":"Stenroos","year":"2018","journal-title":"Injury."},{"issue":"7","key":"bib18-20250430","first-page":"851","article-title":"Pitfalls in automatic limb lengthening - first results with an intramedullary lengthening device","volume":"102","author":"Tiefenboeck","year":"2016","journal-title":"Orthopaedics & Traumatology: Surgery & Research."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.22.00283","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:44:48Z","timestamp":1787751888000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.22.00283"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,15]]},"references-count":18,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.22.00283","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,15]]}}}