Lee M. Zuckerman

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Patients with Ollier's Disease (OD) and Maffucci Syndrome (MS) are at risk for fractures, deformities, and limb‐length discrepancies (LLDs). This study aims to determine the rate and types of surgery performed on these patients and evaluate the prevalence of developing a malignancy at a prior surgical site. A survey link was posted to a private online social media support group page specific to OD and MS patients. A total of 125 surveys were obtained from five continents. Two surveys were incomplete, and 123 surveys were evaluated with 109 OD and 14 MS patients. 89% had at least one surgery at a mean age of 9.1 years, with an overall average of 7.6 surgeries. Common surgical indications included lower‐extremity LLD and deformity correction, and symptomatic enchondroma resection. 19% developed a chondrosarcoma, and 35% of these occurred at a previous surgical site. Four patients developed metastatic disease, and two had an intramedullary nail placed during a prior procedure. The majority of patients with OD and MS will undergo surgery, require multiple procedures, and may develop a chondrosarcoma at a prior surgical site. Caution should be taken in this at‐risk population with special consideration for the type of surgery and implants used.

Case: A 10-year-old boy with a left femur osteosarcoma treated with a growing distal femoral prosthesis developed a 6.5 cm limb-length discrepancy with erosion of the remaining femur. He underwent revision of the replacement with femoral transport and lengthening using an extramedullary lengthening nail. After treatment, his bone stock increased by 14 cm and his discrepancy decreased to 3.6 cm. He ambulates without assistive device using a shoe insert. Conclusions: Extramedullary lengthening can increase bone stock and improve leg lengths. Multiple procedures may be required, and deformities can occur if lengthening is attempted beyond the tip of the intramedullary stem.

Introduction: The use of magnetic resonance imaging (MRI) with a magnetic intramedullary lengthening nail in place is contraindicated per the manufacturer due to the concern of implant activation and migration. A prior in vitro study did not confirm these complications only noting that a 3.0 T MRI weakened the internal magnet. Therefore, a retrospective analysis of patients who underwent an MRI with a magnetic nail in place was performed to determine if any adverse effects occurred in the clinical setting. Materials and methods: A retrospective review of all patients who underwent an MRI with a magnetic lengthening nail in place was performed. The time spent being imaged in the MRI, number of times the patient entered the MRI suite, and the images obtained were recorded. Radiographs were performed before and after the MRI to determine if any hardware complications occurred. The patients were monitored for any adverse symptoms while they were in the suite. Results: A total of 12 patients with 13 nails were identified. Two patients underwent imaging with a 3.0 T MRI while the remaining 10 underwent imaging with a 1.5 T MRI. Each patient entered the MRI suite 2.1 times and spent an average of 84.7 min being imaged in the MRI (range 21–494). No patients noted any adverse symptoms related to the nail while in the suite and no hardware complications were identified. Conclusion: MRI appears to be safe with a magnetic nail in place and did not result in any complications. Given the manufacturer’s recommendations, informed consent should be obtained prior to an MRI being performed and a 3.0 T MRI should be avoided when possible if further activation of the nail is required.