1. Example of a patient with a 5cm limb length discrepancy (LLD)

Surgical Technique:

For decades, external fixation was the best option for limb lengthening. Recent advances have resulted in less invasive alternatives that decrease complications associated with external fixation and improve results.

The PRECICE system is an intramedullary nail (see Image 2) used for limb lengthening of the femur and tibia that utilizes an External Remote Controller (ERC, see Image 3) to non-invasively lengthen the nail.

Image 2. Picture of nail (Ellipse PRECICE femoral nail)

Image 3. ERC

The nail is placed in the bone and locked with bolts on either end and the bone is cut in between. The bone cut is done through a small skin incision to preserve all the soft tissues around the bone. Five to seven days following surgery, the bone is distracted by placing the magnet (ERC) on the skin which then activates the nail to lengthen (see Image 4).

Image 4. Correct alignment of the ERC to the patient’s femur. Always point arrows on ERC toward patient’s feet

Lengthening is done at approximately 1mm per day until the desired length is achieved. Once the length is achieved the consolidation phase starts and the bone heals around the nail.

Image 5. Example of nail lengthening

The key to the technology is the magnetic interaction between the PRECICE nail and the PRECICE ERC (magnet), a portable, hand-held unit that lengthens the PRECICE nail. The PRECICE ERC is programmed in order to accurately lengthen the femur or tibia based upon the surgeon’s prescription. Weekly clinical and radiographic evaluations are performed to confirm the lengthening and new bone formation. The rate of the lengthening may be modified by the surgeon to match the quality of the new bone formation.  The nail can also be used to compress the bone, if required clinically and programmed by the treating physician.

The PRECICE system is used to treat lower limb length discrepancies. It has been used worldwide in over 1000 cases. Its reported and published results in over 250 cases have been excellent with less pain and lower complication rates when compared to the external fixation methods or previous implantable nail systems.

Image 6. Example of a femur being lengthened 4cm

For a video animation of the technique for PRECICE antegrade femoral lengthening please click on the following link:

https://youtu.be/rhSlQmXR5N4

For a video animation of the technique for PRECICE antegrade tibial lengthening please click on the following link:

https://youtu.be/EiCRHCBHZw8

For more information about the PRECICE nail please visit their website at

http://ellipse-tech.com/precice-limb-lengthening-technology/

Post-Operative Care

Immediately after surgery, patients are allowed to partially weight bear on the operated leg(s).

The dressings are changed in the hospital on post-operative day 1 or 2 and then kept until the first clinic visit.

Five to seven days after surgery, the lengthening will begin by using the ERC portable magnet that will be programmed by Dr. Gdalevitch for the appropriate lengthening rate.

Follow-ups after surgery

These are the follow-up intervals with Dr. Gdalevitch you can expect after surgery:

  • Weekly or bi-weekly follow-up for the first 4 weeks after surgery, with radiographs
  • Bi-weekly following the first month until the end of the lengthening, with radiographs
  • Once lengthening is complete, follow-up will be monthly until complete bone consolidation is shown on radiographs.

Potential complications

  • Joint contractures due to lengthening (hip, knee and ankle)
  • Deformity of bone
  • Delayed union, non-union or malunion of bony regenerate
  • Infection of bone (osteomyelitis)
  • Nerve injury due to traction from lengthening (Neuropraxia)
  • Neurovascular injury or Compartment syndrome (very rare)
  • Fat embolism syndrome or Pulmonary embolism (very rare)

For a complete list of the risks and complications, please see Patient info.

Patients who will undergo this procedure should read the following sections in the Patient information tab:

  1. Immediate post-operative care
  2. ERC magnet instructions for lengthening

Thanks and credit to Ellipse technologies for images, videos and information on the PRECICE nail.