Motorized Intramedullary Bone Transport Nail for Reconstruction of a Large Diaphyseal Bone Defect after Tumor Resection in a Child-A Case Report

Highlights What are the main findings? The motorized Intramedullary Bone Transport Nail (IMBTN) successfully reconstructed a large tibial defect in a pediatric patient after tumor resection. Skeletal growth and alignment were preserved without tumor recurrence. What are the implications of the main findings? IMBTN provides an internal, less invasive alternative to traditional reconstructive methods in pediatric oncologic limb reconstruction. IMBTN enables controlled bone transport without disrupting skeletal growth in immature patients.Highlights What are the main findings? The motorized Intramedullary Bone Transport Nail (IMBTN) successfully reconstructed a large tibial defect in a pediatric patient after tumor resection. Skeletal growth and alignment were preserved without tumor recurrence. What are the implications of the main findings? IMBTN provides an internal, less invasive alternative to traditional reconstructive methods in pediatric oncologic limb reconstruction. IMBTN enables controlled bone transport without disrupting skeletal growth in immature patients.Abstract Background: Reconstructing large bone defects in pediatric patients after tumor resection is challenging, as conventional techniques are associated with high complication rates and morbidity. The Intramedullary Bone Transport Nail (IMBTN) may reduce these complications while preserving limb alignment and skeletal growth in pediatric oncologic reconstruction. Methods: A 15-year-old female with an osteofibrous dysplasia-like adamantinoma of the tibial diaphysis underwent complete en-bloc resection, leaving a 9 cm bone defect. An IMBTN (Precice, NuVasive) was implanted for distraction osteogenesis, with distraction starting eight days post-surgery at 0.25 mm twice daily. Follow-up visits monitored bone healing, alignment, and limb length. Results: The 9 cm defect was successfully reconstructed, with complete bone healing at the distraction site. Complete consolidation was confirmed at 18 months. The transport nail was removed at two years, and no further revisions were necessary. At two-year follow-up, the patient reported minimal pain on the Visual Analog Scale 1/10, and no recurrence of the tumor was noted. Conclusions: The use of IMBTN for large bone defect reconstruction following tumor resection in pediatric patients is a safe and effective technique. It enables stable bone transport while preserving alignment, maintaining limb length, and is less invasive than traditional reconstructive approaches.