Extracorporal noninvasive acute retraction of STRYDE for continued lengthening in cases with limited nail stroke: a technical less invasive solution to reload the STRYDE.

With STRYDE nails (NuVasive Specialized Orthopedics, San Diego, CA), lengthening nails for full weight-bearing during callus distraction have been available CE-certified since February 2019 in Europe. At present only antegrade femur nails and tibia nails with various lengths and diameters are available. Due to a mismatch of bone length and realizable (implantable) nail length e.g., in cases of skeletal dysplasia or achondroplastic dwarfism, it may happen that a desired lengthening of 6-8 cm cannot be realized because of a nail stroke from only 5 cm. Retrograde usage of antegrade piriformis nails is technically possible as an individual (off label use) procedure since so far no retrograde implants are available. A new method of surgical intervention for retraction of the STRYDE nails at the end of the nail stroke with ongoing callus distraction in patients with bilateral femoral extension under anesthesia with extracorporeal use of the fast distractor device is described in detail. It is safe and with low risk for a reload of a capacity of 3-4 cm for antegrade and retrograde femoral implantation situation for the patient. The acute reload of the STRYDE nail stroke for further distraction is possible without skin incision or invasive soft tissue approaches. Application of the fast distractor extracorporeal within a few minutes is described in detail. The intervention is technically reproducible and can be performed for the proximal femur with antegrade STRYDE nails as well as for the distal femur with retrograde STRYDE nails in adult patients.