Dr. Herzenberg explains the Precice Internal Lengthening Nail

What is internal limb lengthening?

Internal limb lengthen is when the device used to lengthen the bone is inserted inside the bone. The prolongation device has a small magnetic drive inside it. When the motor is activated by an external Remote Controller ( ERC ), the device slowly lengthens, and this causes the bone to slowly lengthen. previously, the only way to lengthen a bone was to apply a metallic scaffolding to the branch called an external fixator. external fixators are metallic element devices that are attached to the bones with limited thread pins or wires. These threaded pins or wires pass through the skin and muscles and are inserted into the bone. The majority of the prolongation device is outside of the body.

Please visit Limb Lengthening : The march for general information about limb prolongation .

What is the Precice and how does it work?

Precice nail in an adult's femur The Precice Lengthening System ( NuVasive Specialized Orthopedics, San Diego, CA ) consists of a telescope metallic perch, called a lengthen nail, with a magnetic motor inside of it. The nail is inserted through a small incision into the bone canal where the bone marrow is found. The patient is given a especial device called an External Remote Controller ( ERC ) that is used to make the Precice nail lento lengthen. The ERC has a magnet inside it that rotates. When the ERC is placed against the leg or arm and turned on, the movement of the magnet inside the ERC causes the magnetic motive inside the Precice to slowly lengthen. When the Precice lengthens, the bone besides lengthens .

Will Precice lengthening hurt?

Precice lengthening with the ERC is then gradual that closely all of our patients have told us that their leg does not hurt during the lengthen sessions .

What is our center’s experience with the Precice?

The original doctor development team for the Precice smash consisted of Dr. Shawn Standard and Dr. John Herzenberg, both from the International Center for Limb Lengthening, and Dr. Stuart Green. These doctors worked with a ship’s company to produce this revolutionary new internal lengthen smash. Our doctors have been using the Precice system since 2012. The first model that was released was a modular design that was composed of two sections assembled at the time of surgery. The newer model is a unmarried man, which makes the smash much stronger. We have found the Precice to be very effective in helping our patients. In the foremost 100 bones that we treated, 96 % achieved the lengthen goal. In another report that we conducted, patients had lengthening with external fixation and then former had lengthening with the Precice. All the patients in the sketch preferred lengthening with the Precice over external arrested development. They said that they had less annoyance, found physical therapy to be easier and liked the cosmetic appearance of the leg/arm better after discussion with Precice. Since 2012, surgeons at the International Center for Limb Lengthening have implanted more than 600 Precice nails .

Will the Precice be a good option for every person who needs limb lengthening?

The Precice pinpoint is offered in respective lengths and diameters, but a person ’ s bone may still be besides little for it. The diameter of the bone must be wide enough so that the Precice can fit inside the bone canal. The doctor will measure the diameter of the cram on an x ray. The Precice is offered in three diameters : 8.5, 10.7 and 12.5 millimeter ( 0.33, 0.42, 0.50 inches ). The bone besides needs to be hanker enough to fit the Precice. The shortest smash is 6.3 inches ( 160 millimeter ) for the tibia and 6.7 inches ( 170 millimeter ) for the femur. The doctor will measure the duration of the bone on an x-ray to see if it is long enough to accommodate the Precice collar. Another factor that must be considered is whether the ERC can be placed close enough to the Precice to make it lengthen. Soft-tissues ( muscle, fatness, hide ) can be then thick that the ERC can not be placed close enough to the Precice to activate lengthen. To see if the Precice will work for a patient, the doctor will measure the distance from the bone canal to the hide on an roentgenogram. People are not good candidates for the Precice if they have a pacemaker or know that they will need an MRI scan in the adjacent year. It is generally not recommended to have an MRI scan when a person has a Precice breeze through implanted. therefore, we routinely recommend removal of the Precice about one year after surgery, provided that the lengthen bone is in full healed .

Can the Precice internal nail be used in children?

A Precice nail may be inserted in a child ’ mho second joint bone ( femur ) start at about age eight years. For the tibia bone ( tibia ), it is preferable to wait until close to skeletal maturity ( senesce 14 years in girls and age 16 years in boy ) .

How much will the Precice lengthen a bone?

The bone is lengthened in identical little amounts each day until the prolongation goal is achieved. The maximal sum that can be lengthened depends on which model of the Precice is used. different Precice models can lengthen the bone a sum of 1.2 inches ( 30 millimeter ), 2 inches ( 50 millimeter ) or 3 inches ( 80 millimeter ). For example, if the shortest Precice is the only one that fits in the bone, the patient may be limited to lengthening a sum of 1.2 inches. In most cases, we can implant the models that allow 2 to 3 inches of length .Brochure cover for prehabilitation stretches to prepare for limb lengthening surgery featuring a man using a stretch band on his leg and foot To help you prepare for limb lengthening surgery success, we have developed this brochure of prehabilitation stretches to perform in the months prior to surgery. This is not medical advice; please consult with your doctor before beginning any exercise regime.

What should be done to prepare for surgery?

Please visit our Before Surgery part for detailed information. During the visit with the doctor, ask for our steer to prepare for surgery. When planning for Precice surgery, you should besides be aware of the following :

  • Schedule any necessary MRI scans before surgery: The patient may not be allowed to have an MRI scan after the Precice is inserted. An magnetic resonance imaging scan could de-magnetize the Precice nail down, making it unable to lengthen .
  • Learn about the precautions that should be taken with the ERC: If any family members have a cardiac pacemaker, the ERC will need to be kept away from them. The magnet in the ERC could affect the function of some pacemakers. The attraction in the ERC can besides adversely involve items such as accredit cards, charismatic room keys and cell phones .
  • Prepare for the ERC to be loud: When the ERC is being used to lengthen, it is forte ! Parents may want their children to become conversant with the sound before the operation. Watch this video recording to hear what it sounds like when the ERC is being used to lengthen the Precice :

Demonstration of how the ERC is used to lengthen the Precice

How is the Precice inserted during surgery?

The doctor of the church needs to make space for the device to fit inside the bone. The knocked out separate of a bone is made up of hard tissue, but the at heart of a bone is made up gentle marrow tissue. The doctor will use an orthopedic drill to create a duct in the kernel cavity in the focus on of the bone. This canal will be large enough for the Precice to fit inside it.

The way the Precice is inserted depends on the bone and the affected role ’ sulfur unique situation :

  • For the femur ( second joint cram ), the device may be inserted in two different ways :
    • One way that the Precice can be inserted is through the lead of the femur that is closest to the pelvis. This insertion from the hip towards the knee is called antegrade interpolation. The example below shows how the nail is inserted, the peel incisions that are made, and where the bone may be cut ( osteotomy ) and lengthened .

Illustrations showing antegrade insertion of a Precice nail into the femur for limb lengthening and deformity correction

    • Another way that the Precice can be inserted is through the bottom of the femur that is closest to the knee. This insertion from from the knee towards the hip is called retrograde insertion. The exemplification below shows how the collar is inserted and the locations of the peel incisions and bone cut ( osteotomy ). eminence that the localization of the magnet in the femur when the Precice is inserted retrograde is unlike than when the Precice is inserted antegrade. The location of the magnet will affect where the patient places the ERC on the second joint. When the ERC is turned on and placed against the peel of the thigh, it causes the Precice to slowly lengthen .

Illustrations showing retrograde insertion of a Precice nail into the femur for limb lengthening and deformity correction

  • For the tibia ( tibia cram ), the device will about always be inserted from the crown of the tibia that is closest to the stifle. The example below shows how the pinpoint is inserted, the bark incisions that are made, and where the tibia and fibula may be cut ( osteotomy ) and lengthened .

Illustrations showing insertion of a Precice nail into the tibia for limb lengthening and deformity correction

  • For the humerus ( amphetamine weapon bone ), the device will be inserted through the circus tent of the humerus that is closest to the shoulder ( from the shoulder towards the elbow ) .

Illustration showing a Precice nail being used to lengthen an adult's humerus (upper arm)

What happens after Precice insertion surgery?

After the Precice is inserted, the patient will stay in the hospital for 2 to 3 days. Our doctors prefer that the affected role stays in the Baltimore sphere for at least the beginning 2 weeks after being discharged from the hospital. While using the ERC to lengthen the Precice ( called the distraction phase ), the patient will need to return to the ICLL for postoperative visits approximately every 10 to 14 days. After the beguilement phase of treatment is completed, the consolidation phase starts where the bone solidifies and heals. The patient will need to return to the ICLL every calendar month until the bone is healed. physical or occupational therapy is critical during the beguilement and consolidation phases of treatment. During therapy, the muscles, tendons and ligaments are stretched in regulate to ensure that the sleeve or leg will have full apparent motion after discussion. Patients will need physical therapy if they are lengthening the bones in the leg or occupational therapy if they are lengthening the humerus ( upper arm bone ). Our doctors may or may not allow this to be done in the patient ’ s home township, since some people need more specify physical therapy, which is available at our center. The Rubin Institute ’ s forcible therapy platform for arm prolongation patients, led by Anil Bhave, PT, is the most experienced in the United States, if not the world. If patients require specialize forcible therapy, they will need to stay in Baltimore for that period of time. In many cases, we besides prescribe special braces/splints. These are by and large made for the patient during the week after operation. The affected role will be allowed only express burden bearing on the leg with the Precice in it. The sophisticate will determine how much weight unit bear is allowed on the peg based on each alone situation and the size and type of the Precice nail that is implanted. If both legs will be lengthened, the patient will need to be in a wheelchair. Please talk to the surgeon if the patient needs to visit the dentist for act clean or dental surgery during discussion. After the Precice is inserted, special antibiotics may be necessary in order to have dental work .

How is the ERC used to lengthen the bone?

When the ERC is turned on and placed against the skin of the leg or arm, it causes the Precice to slowly lengthen. When the Precice lengthens, the bone besides lengthens. The ERC will stop when the affected role has completed the discipline sum of lengthening for that school term. When the arm or leg is swollen or has thick soft tissues, the doctor of the church may instruct the affected role to place the ERC against the peel and apply imperativeness to compress the piano tissues so that the ERC is closer to the Precice. Magnets work good when they are closer. Panels A and B below display MRI scans of a cross section of a thigh. The loss arrow in jury a shows the distance between the ERC and the center of the bone ( where the Precice would be inserted ). In panel B, the clamber and soft tissues are compressed so that the distance between the ERC and the Precice would be reduced ( the red arrow in panel B is shorter than the crimson arrow in panel A ). Two MRIs show how compressing the skin/tissue on the thigh helps the ERC get closer to the Precice

How often will the patient need to use the ERC?

The surgeon will prescribe how many separate lengthen sessions need to be done each day and the amount of lengthening for each session. typically, patients are asked to lengthen the cram 0.75 to 1 mm each sidereal day ( 0.03 to 0.04 inches ; there are 25 mm in 1 column inch ).

For case, a patient could be asked to lengthen 0.25 mm during four different sessions throughout the day, which would result in a entire of 1 millimeter of lengthening each day. Each session with the ERC would takes about 2 minutes to lengthen the bone 0.25 millimeter. Four sessions would take a total of 8 minutes per day .

When can the Precice be removed?

typically, the Precice is removed approximately 1 class after insertion. The removal procedure is an outpatient surgery, which means that the affected role does not need to stay in the hospital overnight after the removal. The lengthen cram should be in full and circumferentially healed before considering removal of the Precice .

Why choose the International Center for Limb Lengthening?

Click here to learn why patients choose to be treated at the International Center for Limb Lengthening .

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