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
Willa age 8 with #russellsilversyndrome had femur #leglengthening for #limblengthdiscrepancy with #precicenail Really quick bone healing. #hsskids #pediatricorthopedics #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 .
Misei had #staturelengtheningsurgery gaining 5 inches of height from first femur and then staged tibia #leglengtheningsurgery with #precicenail Femur nails have been removed in second Xray showing the tibia lengthening Precice nail #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 #staturelengthening #shortstature
David from Texas 2 months post 57 mm femur #leglengthening for #leglengthdiscrepancy with #precicenail Now age 15, this is his second lengthening. Several years back I did 6 cm of tibia lengthening. In total we corrected what would have been 12 cm of #limblengthdiscrepancy #hsskids #pediatricorthopedics #russellsilversyndrome #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
Miriam with #growtharrest that led to #leglengthdiscrepancy short femur and proximal tibia recurvatum and valgus oblique plane deformity. Treatment included femur #precicenail #leglengthening and tibia oblique plane #osteotomy #hsskids #pediatricorthopaedics #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
Rowan 11 weeks post femur #limblengtheningsurgery #precicenail extramedullary technique for young children when bone too small for intramedullary technique. #hsskids #pediatricorthopedics #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
Lucas from Iowa with fast healing and recovery after femur #limblengtheningsurgery #precicenail #precice #hsskids #pediatricorthopaedics #russellsilversyndrome #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
Here is the completion story for Mr M. As a reminder, he had a tibia fracture in Bangladesh with a protracted healing course. I used his existing frame to heal the fracture, but he was now 2 cm short and struggled with walking. So I then lengthened him with a @globusmedicalinc #precicenail #globustrauma . Here is his xray showing he is fully healed, and his pelvis is level. He is very happy to have the frame off and have equal leg lengths! Here he is walking and feeling great! Look for him as the driver of your next #nyctaxi
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#all4ortho #hssllcrs #hsslimblengthening #hspecialsurgery #limblengthening
Like all good research this paper was a labor of love, and I’m so glad to finally see it published! If you want to learn about limb lengthening, give it a read; it’s #openaccess meaning free!
TLDR: lengthening the femur (especially in the shaft) is associated with faster recovery than with the tibia. Younger age and atraumatic lengthening (for stature/height rather than to correct a congenital deficit) are also associated with shorter recovery times.
#precice #precicenail #limblengthening #bonelengthening #stature #staturelengthening #femurlengthening #orthopedics #orthopedicsurgery #heightsurgery
