Pediatric Lower Limb Lengthening Using the PRECICE Nail: Our Experience With 50 Cases

Abstract

Background: Limb lengthening using intramedullary externally controlled motorized devices is becoming increasingly popular. There is limited literature regarding their use in the pediatric and adolescent population. This study reviews outcomes on 50 consecutive cases of intramedullary lower limb lengthening surgery in this population. Methods: A retrospective review of all pediatric and adolescent patients treated in our institution by intramedullary lengthening for lower limb length discrepancy using the PRECICE and STRYDE intramedullary lengthening nails between 2013 and 2019. All patients were operated by a single surgeon. Data were prospectively recorded. We report on nail accuracy and reliability, consolidation index, time to full weight-bearing from completion of lengthening, joint range of movement, ASAMI bone and functional scores, presence of problems, obstacles and complications, and patient reported outcome measures (PROMS). Results: Fifty cases (43 femoral and 7 tibial nails) were performed in 42 patients (20 males, 48% and 22 females, 52%). Six patients had bilateral lengthening and 2 patients had sequential lengthening. There were 28 antegrade femoral, 13 retrograde femoral and 5 tibia PRECICE nails, 2 tibial and 2 femoral PRECICE STRYDE nails. Mean age at surgery was 15 years old (12 to 17). Mean preoperative length discrepancy was 49 mm (20 to 90). Mean achieved lengthening was 46.5 mm (20 to 80). Mean percentage lengthening was 12.6% (5% to 25%). Nail accuracy was 96% and reliability 90%. Average distraction rate was 0.92 mm/d for femur and 0.64 mm/d for tibias. Consolidation index was 28 d/cm (18 to 43) and 39 d/cm (20 to 47), respectively. Time from completion of lengthening to independent full weight-bearing as observed in clinic was 45 days (21 to 70) and 34.2 days (23 to 50), respectively. ASAMI bone and functional scores were favorable and PROMS demonstrated high patient satisfaction levels. No significant complications were observed. Conclusions: We have demonstrated excellent clinical results and high patient satisfaction with intramedullary lengthening in a pediatric/adolescent population. We highly recommend thorough preoperative preparation, patient education, and a multidisciplinary approach. Level of Evidence: Level IV.

Limb lengthening with PRECICE magnetic nail in pediatric patients: A systematic review

“…Studies by Szymczuk et al [ 30 ] and Hammouda et al [ 32 ] compared the PRECICE intramedullary nailing with external fixation, but in our analysis, we only took into account the PRECICE nailing results. In studies by Nasto et al [ 27 ] and Iliadis et al [ 29 ], both retrograde and antegrade approaches were used, and some tibia nailing was included. Other studies preferred the antegrade approach to the femur.…”

“…The average lengthening achieved reported by Nasto et al [ 27 ] was 4.4 ± 1.2, with a nail accuracy and reliability of 91% and 88% respectively. Iliadis et al [ 29 ] reported a nail accuracy of 96% and a nail reliability of 98%, due to a single case where a nail was implanted without lengthening because of the patient’s mental health issues.…”

“…Among the articles, the results were almost comparable. Szymczuk et al [ 30 ] described a DI of 0.7 ± 0.18, while Iliadis et al [ 29 ] reported a DI of 0.92 (0.67-1). Furthermore, this latter retrospective review was the only one considering the days to full weight bearing from lengthening accomplishment with a mean of 45 days.…”

Pain, osteolysis, and periosteal reaction are associated with the STRYDE limb lengthening nail: a nationwide cross-sectional study

“…Unrelated to these adverse events, the MHRA also raised concerns about a potentially "inappropriate use in children and adolescents" (British Orthopaedic Association 2021). The MHRA acknowledges a widespread use of PRECICE devices in this age group, but highlights that the nails have not been validated for use in these patient groups (Frommer et al 2018, Nasto et al 2020, Iobst 2020, Iliadis et al 2021, Vogt et al 2021. In our study, 10/27 patients were younger than 18 years old with the youngest patient being 11 years of age.…”

The STRYDE limb lengthening nail is susceptible to mechanically assisted crevice corrosion: an analysis of 23 retrieved implants

“…Interestingly, Lee et al (2017) describe broken bushings of PRECICE nails, but no corrosion. However, based on these studies and the body of evidence, clinical application of the titanium PRECICE nail is relatively safe (Alrabai et al 2017, Calder et al 2019, Horn et al 2019, Hammouda et al 2020, Morrison et al 2020, Nasto et al 2020, Frost et al 2021, Iliadis et al 2021b.…”