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Case Reports
. 2020 Feb 28;12(2):e7130.
doi: 10.7759/cureus.7130.

Dislodgement of Telescopic Nail from the Epiphysis: A Case Report with an Analysis of Probable Mechanism

Affiliations
Case Reports

Dislodgement of Telescopic Nail from the Epiphysis: A Case Report with an Analysis of Probable Mechanism

Prateek Behera et al. Cureus. .

Abstract

Telescopic nails such as Fassier-Duval (FD) nails have become the standard treatment for stabilizing long bones and correcting deformities in osteogenesis imperfecta (OI). These nails do not require repeat surgery for their replacement when the bones outgrow them. However, they are not completely free from complications. The prohibitive costs of the original implants have led to design modifications being introduced in locally manufactured telescopic nails. While these low-cost devices work well in most cases, they can lead to complications resulting from their design flaws. We present here the complication observed in a locally manufactured telescopic nail with a design similar to the FD nail. The male component of the nail got dislodged from the distal tibial epiphysis, resulting in its proximal migration. We discuss the probable mechanism of this complication and propose possible design changes that can bring down the rates of such incidences.

Keywords: complication; fassier-duval nail; migration; osteogenesis imperfecta; pamidronate; sofield and millar; sureshot; telescopic nail.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Anteroposterior radiograph of the patient at presentation showing LCP in situ on the right side and TENS on the left side
LCP: locking compression plates; TENS: Titanium Elastic Nail System
Figure 2
Figure 2. Immediate postoperative radiographs of the patient
2A: right femur; 2B: right tibia
Figure 3
Figure 3. Follow-up radiograph of the right tibia
The image shows the male component of the nail getting dislodged (white arrow) from the epiphysis
Figure 4
Figure 4. Follow-up radiograph of the right femur
The image shows that the threads of the male rod are well embedded in the epiphysis (white arrow). The left femur has TENS in situ inserted at a different center TENS: Titanium Elastic Nail System
Figure 5
Figure 5. Radiographs obtained during the follow-up visit six months after the second surgery
Figures 5A and 5B show the anteroposterior and lateral views of the right tibia with the male component dislodged from the tibial epiphysis (white arrow). Figures 5C and 5D show the anteroposterior and lateral views of the left femur, with the arrows showing the Park Harris lines. Figures 5E and 5F show the anteroposterior and lateral views of the left tibia where the nail was inserted without any osteotomy
Figure 6
Figure 6. Comparison of the designs of three different Fassier-Duval nails
Figures 6A, 6B, and 6C show the profile and features of the tips of the male rods manufactured by Universal Orthosystems, Pega Medical, and Uma Surgicals respectively

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