{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:41:15Z","timestamp":1791380475976,"version":"4.3.3"},"reference-count":32,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,11,25]],"date-time":"2024-11-25T00:00:00Z","timestamp":1732492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health","award":["RCR-2022-23682299"],"award-info":[{"award-number":["RCR-2022-23682299"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Fibrous dysplasia (FD) is a rare condition in which normal spongy and cortical bone is replaced by non-neoplastic fibrous tissue, leading to weakened bone matrix and increased risk of pathological fractures and deformities. Treating these deformities poses a significant challenge for surgeons. While various cases of surgical stabilization and limb lengthening using intramedullary nails have been reported, there is limited evidence on the use of Motorized Intramedullary Limb-Lengthening Nails (MILLNs) in FD patients. This case report presents the clinical history of a patient with FD who underwent multiple surgical interventions to address severe lower limb length discrepancy (LLD) and angular deformity caused by multiple fractures. Case presentation: A sixteen-year-old Caucasian girl with polyostotic FD developed a severe post-traumatic LLD of 10 cm on the right side, associated with coxa vara, valgus knee, and patellar instability. The deformity of the proximal femur was addressed with a valgus and derotational femoral osteotomy. However, this procedure exacerbated the knee\u2019s valgus deformity and only partially corrected the LLD, leading to the decision to proceed with femoral lengthening. A retrograde magnetic intramedullary nail (PRECICE, NuVasive) was utilized for this purpose. Approximately three months postoperatively, radiographs revealed the loosening of the proximal anchoring screw, while the nail had reached maximum distraction. We then proposed reactivating the previously implanted nail. Nine months after the final surgery, standing long-leg radiographs showed a residual shortening of 1 cm, with excellent healing at the fracture sites and the nail and screws remaining securely in place. The patient was monitored regularly, with the latest follow-up occurring four years and five months after the conclusion of the last lengthening procedure. Conclusions: This case report describes the reactivation of a MILLN in a patient with polyostotic fibrous dysplasia. While nail reactivation has been previously described in the literature, to our knowledge, it has not been reported for treating complications arising from FD. In cases of mechanical complications, this approach can equalize leg length discrepancies and correct deformities, avoiding additional invasive surgeries and reducing healthcare costs. As this is an off-label treatment, preoperative consent from both the patient and the parents is required.<\/jats:p>","DOI":"10.3390\/life14121543","type":"journal-article","created":{"date-parts":[[2024,11,25]],"date-time":"2024-11-25T05:21:32Z","timestamp":1732512092000},"page":"1543","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Reactivating Sleeping Intramedullary Nail in a 16-Year-Old Female with Polyostotic Fibrous Dysplasia: A Case Report on Complications and Potential Solutions"],"prefix":"10.3390","volume":"14","author":[{"given":"Marco","family":"Todisco","sequence":"first","affiliation":[{"name":"Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianna","family":"Viotto","sequence":"additional","affiliation":[{"name":"Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4734-6741","authenticated-orcid":false,"given":"Laura","family":"Campanacci","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Oncology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni Luigi","family":"Di Gennaro","sequence":"additional","affiliation":[{"name":"Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7368-4935","authenticated-orcid":false,"given":"Alessandro","family":"Depaoli","sequence":"additional","affiliation":[{"name":"Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 90011 Bagheria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3757-1212","authenticated-orcid":false,"given":"Gino","family":"Rocca","sequence":"additional","affiliation":[{"name":"Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0361-9920","authenticated-orcid":false,"given":"Giovanni","family":"Trisolino","sequence":"additional","affiliation":[{"name":"Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Kim, H.Y., Shim, J.H., and Heo, C.Y. (2023). A Rare Skeletal Disorder, Fibrous Dysplasia: A Review of Its Pathogenesis and Therapeutic Prospects. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms242115591"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1007\/s00223-019-00550-z","article-title":"Fibrous Dysplasia of Bone and McCune\u2013Albright Syndrome: A Bench to Bedside Review","volume":"104","author":"Hartley","year":"2019","journal-title":"Calcif. Tissue Int."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"885","DOI":"10.2174\/1871530319666181226103700","article-title":"Mazabraud\u2019s Syndrome: A Case Report and Up-To-Date Literature Review","volume":"19","author":"Vescini","year":"2019","journal-title":"Endocr. Metab. Immune Disord. Drug Targets"},{"key":"ref_4","first-page":"1848","article-title":"Fibrous dysplasia. Pathophysiology, evaluation, and treatment","volume":"87-A","author":"Dicaprio","year":"2005","journal-title":"J. Bone Jt. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Zhai, X., Duan, L., Yao, Y., Xing, B., Deng, K., Wang, L., Feng, F., Liang, Z., You, H., and Yang, H. (2021). Clinical Characteristics and Management of Patients With McCune-Albright Syndrome With GH Excess and Precocious Puberty: A Case Series and Literature Review. Front. Endocrinol., 12.","DOI":"10.3389\/fendo.2021.672394"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"S79","DOI":"10.1016\/j.injury.2019.03.045","article-title":"Limb lengthening and deformity correction in children with abnormal bone","volume":"50","author":"Popkov","year":"2019","journal-title":"Injury"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1186\/s10195-023-00705-7","article-title":"Lower-limb intramedullary nailing in patients with polyostotic fibrous dysplasia who had a previous unsuccessful treatment. A report of 48 cases","volume":"24","author":"Ippolito","year":"2023","journal-title":"J. Orthop. Traumatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1186\/1750-1172-7-S1-S1","article-title":"The surgical management of fibrous dysplasia of bone","volume":"7","author":"Stanton","year":"2012","journal-title":"Orphanet J. Rare Dis."},{"key":"ref_9","first-page":"98","article-title":"Fibrous dysplasia of bone: Surgical management options and outcomes of 22 cases","volume":"9","author":"Fang","year":"2018","journal-title":"Mol. Clin. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"41","DOI":"10.5005\/jp-journals-10080-1523","article-title":"Deformity correction, surgical stabilisation and limb length equalisation in patients with fibrous dysplasia: A 20-year experience","volume":"16","author":"Hampton","year":"2021","journal-title":"Strateg. Trauma. Limb Reconstr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.jor.2020.03.014","article-title":"Lower limb lengthening and deformity correction in polyostotic fibrous dysplasia using external fixation and flexible intramedullary nailing","volume":"21","author":"Popkov","year":"2020","journal-title":"J. Orthop."},{"key":"ref_12","first-page":"P105","article-title":"Surgery for fibrous dysplasia","volume":"22","author":"Stanton","year":"2007","journal-title":"J. Bone Miner. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1177\/1602400321","article-title":"Use of a magnetic bone nail for lengthening of the femur and tibia","volume":"24","author":"Karakoyun","year":"2016","journal-title":"J. Orthop. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"106","DOI":"10.5005\/jp-journals-10080-1592","article-title":"Re-use of Motorised Intramedullary Limb Lengthening Nails","volume":"18","author":"Georgiadis","year":"2023","journal-title":"Strateg. Trauma Limb Reconstr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1097\/BPO.0000000000001047","article-title":"Lengthening With Monolateral External Fixation Versus Magnetically Motorized Intramedullary Nail in Congenital Femoral Deficiency","volume":"39","author":"Szymczuk","year":"2019","journal-title":"J. Pediatr. Orthop."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1007\/s00064-009-1709-4","article-title":"The reverse planning method for lengthening of the lower limb using a straight intramedullary nail with or without deformity correction. A new method","volume":"21","author":"Baumgart","year":"2009","journal-title":"Oper. Orthop. Traumatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1002\/jor.20026","article-title":"Radiographic classification of osteogenesis during bone distraction","volume":"24","author":"Li","year":"2006","journal-title":"J. Orthop. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e44","DOI":"10.1097\/BPO.0000000000001672","article-title":"Pediatric Lower Limb Lengthening Using the PRECICE Nail: Our Experience with 50 Cases","volume":"41","author":"Iliadis","year":"2021","journal-title":"J. Pediatr. Orthop."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"108182","DOI":"10.1016\/j.ijscr.2023.108182","article-title":"Breakage of a re-activated PRECICE\u00ae nail: A case report","volume":"106","author":"Alrabai","year":"2023","journal-title":"Int. J. Surg. Case Rep."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1007\/s11751-018-0317-y","article-title":"Two consecutive limb lengthenings with the same PRECICE nail: A technical note","volume":"13","author":"Couto","year":"2018","journal-title":"Strateg. Trauma Limb Reconstr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.jcot.2020.06.005","article-title":"Post-retrieval functionality testing of PRECICE lengthening nails: The \u201cSleeper\u201d nail concept","volume":"14","author":"Eltayeby","year":"2020","journal-title":"J. Clin. Orthop. Trauma"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1080\/17453674.2018.1534321","article-title":"Limb lengthening and deformity correction with externally controlled motorized intramedullary nails: Evaluation of 50 consecutive lengthenings","volume":"90","author":"Horn","year":"2019","journal-title":"Acta Orthop."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"169","DOI":"10.5152\/j.aott.2023.23026","article-title":"Deformity correction and limb lengthening with externally controlled motorized extendable intramedullary nails: Comparison of 2 different nails","volume":"57","author":"Safi","year":"2023","journal-title":"Acta Orthop. Traumatol. Turc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1302\/0301-620X.101B9.BJJ-2018-1271.R1","article-title":"Femoral lengthening using the Precice intramedullary limb-lengthening system: Outcome comparison following antegrade and retrograde nails","volume":"101-B","author":"Calder","year":"2019","journal-title":"Bone Jt. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"E616","DOI":"10.1097\/BPO.0000000000002133","article-title":"Two-stage Bone Lengthening with Reuse of a Single Intramedullary Telescopic Nail in Patients with Achondroplasia","volume":"42","year":"2022","journal-title":"J. Pediatr. Orthop."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"E85","DOI":"10.1097\/BPB.0000000000000822","article-title":"Maximizing length with precice nail: A novel technique","volume":"31","author":"Sanpera","year":"2022","journal-title":"J. Pediatr. Orthop. B"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1058","DOI":"10.15537\/smj.2019.10.24019","article-title":"Limb lengthening with one Precice nail over its capacity","volume":"40","author":"Kariksiz","year":"2019","journal-title":"Saudi Med. J."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Teuli\u00e8res, M., Langlais, T., Sales de Gauzy, J., R\u00f6lfing, J.D., and Accadbled, F. (2021). Bone Lengthening with a Motorized Intramedullary Nail in 34 Patients with Posttraumatic Limb Length Discrepancies. J. Clin. Med., 10.","DOI":"10.3390\/jcm10112393"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"77","DOI":"10.5005\/jp-journals-10080-1430","article-title":"Blocking Screw-assisted Intramedullary Nailing Using the Reverse-rule-of-thumbs for Limb Lengthening and Deformity Correction","volume":"14","author":"Dabash","year":"2019","journal-title":"Strateg. Trauma Limb Reconstr."},{"key":"ref_30","first-page":"98","article-title":"Regenerate Deformity with the Precice Tibial Nail","volume":"15","author":"Wright","year":"2020","journal-title":"Strateg. Trauma Limb Reconstr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1097\/00003086-199001000-00011","article-title":"Problems, Obstacles, and Complications of Limb Lengthening by the Ilizarov Technique","volume":"250","author":"Paley","year":"1990","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/j.otsr.2012.05.010","article-title":"Classification of complications after progressive long bone lengthening: Proposal for a new classification","volume":"98","author":"Lascombes","year":"2012","journal-title":"Orthop. Traumatol. Surg. Res."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/14\/12\/1543\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:38:53Z","timestamp":1760114333000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/14\/12\/1543"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,25]]},"references-count":32,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["life14121543"],"URL":"https:\/\/doi.org\/10.3390\/life14121543","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,25]]}}}