Use of a magnetic intramedullary nail for axial compression in endoprosthetic reconstruction of the humerus: a description of technique.

Pathological fractures, both completed and impending, of the humeral diaphysis from primary or metastatic disease demand a reconstruction that restores stability while preserving shoulder function and alleviating pain. Conventional reconstructive approaches include the use of long-stemmed endoprosthetic devices, plate-and-screw fixation or intramedullary nailing, all of which can be limited in their success when residual bone is short or biologically weak. This case study details the management of a patient with metastatic leiomyosarcoma who presented with refracture through a previously cement-augmented lesion. Following resection, the diaphyseal defect was spanned using a custom humeral cage. A NuVasive PRECICE magnetically controlled intramedullary nail, pre-lengthened before insertion, was placed through the cage and shortened intraoperatively to achieve axial compression between the cage and bone segments. At the 6 month follow-up, the patient had excellent shoulder range of motion, apparent ingrowth into the cage, and he was able to resume activities of daily living with minimal pain.

Duke Scholars

Author William Curtis Eward Orthopaedic Surgery