What Is a Bone Length Discrepancy?
Our service is dedicated to correcting limb length discrepancies through bone regeneration. A limb length discrepancy (LLD) is defined as one arm or leg shorter in length than the other. It can affect the entire limb or just part of it. LLDs are very common, and many people have a small difference in leg or arm length that they don’t even notice and doesn’t need treatment. However, as discrepancy increases over 1cm or ½ in, it becomes increasingly problematic, especially in the legs. Unequal leg lengths can lead to pain in the low back, hips and knees, and correction is generally recommended.
How Are Bones Lengthened?
Bone lengthening starts with a controlled break in the bone, which is then slowly pulled apart, allowing the bone to partially heal as it gets longer. When the final distance is reached and the bone fully heals, the limb is longer and made of the same bone as the rest of the body. Pulling the bone apart can be achieved with external devices, like ringed external fixators or simple linear rails, or with internal lengthening nails. While multiple lengthening nails exist, we primarily use a magnetically driven device called the Precice nail.
What is The Precice Nail?
The Precice nail is a telescopic metal rod with a gear system and magnet that’s inserted into the center of the bone during surgery. The bone is divided by an osteotomy, and the nail is secured in place with screws. After surgery, a patient is given a handheld External Remote Controller (ERC) that has a rotating magnet inside. The ERC can be used to slowly lengthen the nail by making the magnet spin. The ERC is customizable to each patient’s needs and can be used at home.
How Much Additional Length Can Be Achieved?
The Precice nail can be used to lengthen the femur, tibia, or humerus up to 8 centimeters (lengthening the forearm still requires external fixation). Lengthening surgery with internal expandable nails is considered accurate, safe, and more comfortable for patients than external fixation methods. It has a low complication rate and high patient satisfaction rate.
Femur Lengthening Before and After Images
Tibia Lengthening Before and After Images
Upper ExtremityLengthening Before and After Images
Videos
Carol had a tibia nonunion bone defect. This was a limb salvage challenge. I used the precise compression nail on the tibia and made up the length with a femur lengthening. This was a very practical and efficient way to deal with a complex problem in a middle age patient. #precicenail #limbsalvage #tibianonunion #Rozbruch #aaos #llrs #orthopedicsurgery #liveyourbestlife @all4ortho #orthopedicsurgeon #hospitalforspecialsurgery #limblengthening @hspecialsurgery @limbdeformity @reifmd #SRobertRozbruchMD www.limblengthening.com www.hss.edu/limblengthening www.hss.edu/LSARC #hssLLCRS #HSSlimbLengthening
Viktoria @viktoriamodesta from California making great progress after tibia deformity correction, Osseointegration Limb Replacement Surgery and femur lengthening with #precicenail #osseointegrationlimbreplacement https://www.hss.edu/osseointegration-limb-replacement.asp #osseointegration #amputationsurgery #amputee #cyborgsworld @cyborgsworld #amputeelife #amputeestrong #amputation #osseointegrationUSA www.osseointegrationUSA.com #prostheticlimb #prostheticleg #prostheticsandorthotics #limbreplacementsurgery #limbreplacement #osseointegrationaustralia #osseointegrationswholift #Rozbruch #aaos #llrs #orthopedicsurgery #liveyourbestlife @all4ortho #orthopedicsurgeon #hospitalforspecialsurgery #limblengthening @hspecialsurgery @limbdeformity @reifmd #SRobertRozbruchMD www.limblengthening.com www.hss.edu/limblengthening www.hss.edu/LSARC #hssLLCRS #HSSlimbLengthening @ALM_Ortho custom implant made with the Electron Beam Melting (EBM) 3D manufacturing process (Disclosure: I own stock in the company)
Lynsey from San Francisco had 5 cm #leglengthdiscrepancy related to #arthrogryposis She is symmetrical now after #leglengtheningsurgery with #precicenail #Rozbruch #aaos #llrs #orthopedicsurgery #liveyourbestlife @all4ortho #orthopedicsurgeon #hospitalforspecialsurgery #limblengthening @hspecialsurgery @limbdeformity @reifmd #SRobertRozbruchMD www.limblengthening.com www.hss.edu/limblengthening www.hss.edu/LSARC #hssLLCRS #HSSlimbLengthening
Improvement in #scoliosis after correction of #leglengthdiscrepancy #limblengthdiscrepany #Rozbruch Equalization of leg lengths will correct or improve scoliosis #aaos #llrs #orthopedicsurgery #liveyourbestlife @all4ortho #orthopedicsurgeon #hospitalforspecialsurgery #limblengthening @hspecialsurgery @limbdeformity @reifmd #SRobertRozbruchMD www.limblengthening.com www.hss.edu/limblengthening www.hss.edu/LSARC #hssLLCRS #HSSlimbLengthening #precicenail
This patient had a #limblengthdiscrepancy due to #limbtrauma many years ago. She had pain in her back and her knees. I lengthened her left femur with a #globusmedicalinc #precicenail and now she walks better and is happier!
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#all4ortho #hssllcrs #hsslimblengthening #hspecialsurgery
Eddy has correction of a 13 cm leg length discrepancy by lengthening the femur and tibia using Precice nails. This has had a dramatic effect on his life. Incredible improvements in function, body image, and self-esteem. #precicenail #leglengthdiscrepancy #Rozbruch #aaos #llrs #orthopedicsurgery #liveyourbestlife @all4ortho #orthopedicsurgeon #hospitalforspecialsurgery #limblengthening @hspecialsurgery @limbdeformity @reifmd #SRobertRozbruchMD www.limblengthening.com www.hss.edu/limblengthening www.hss.edu/LSARC #hssLLCRS #HSSlimbLengthening
This patient had a congenitally short limb, meaning the whole leg was affected, without a specific other diagnosis. It also means the solution must account for each segment for the best outcome.
So I lengthened the femur and the tibia (along with correcting its valgus and rotational deformity) instead of just one bone.
However the lengthened tendons often make foot deformity worse, so I then transferred a deforming tendon to the other side of the foot and gradually corrected the foot contracture. His mother is thrilled how much taller he stands now!
Happy Holidays from the Reif’s!
#hsslimblengthening #hssllcrs #precicenail #congenital #limblengthening #orthopedics #orthopedicsurgery #bonelengthening #limbdeformity #footandanklesurgeons #femurlengthening #congenitallimbdifference
This patient (and a neighbor!) presented with a short bowed leg as well as a very malpositioned tibial tubercle, so the knee cap slid down the middle of her knee instead of the front! This is both uncomfortable and significantly compromises the strength needed to straighten the leg.
To address these concerns, she required an osteotomy to straighten and lengthen and another adjacent osteotomy to fix the tubercle. It’s a lot of surgery all in one area, so scar tissue is a real concern, but she did an amazing job with PT and has full knee motion and strength today!
Given positive cat feedback, here is our other cat 🐈⬛.
#hssllcrs #hsslimblengthening #precicenail #osteotomy #bowleg #limblengthening #bone #bonelengthening #orthopedics #tibia #orthopedicsurgery #bonedeformity #deformity
