Limb Lengthening with an External Remote Controller

Limb length discrepancy is a difference in the length of legs or arms. The PRECICE nail is one treatment option for limb length discrepancy. PRECICE is a magnetically controlled device that can be used to lengthen the femur (the thigh bone), tibia (the main bone in the lower leg), and humerus (the bone in your upper arm between your elbow and shoulder). The PRECICE nail is controlled by an External Remote Controller (ERC).

You can find more information about PRECICE at the manufacturer’s website: www.reachyourheight.com

The hospital stay is approximately 1-2 nights for most limb lengthening surgery. You can expect to be ready to discharge once you are tolerating oral pain medication, have passed physical therapy, and are educated on using the ERC to perform the lengthening at home.

You will wear a leg brace, knee immobilizer or hinged knee brace that will help keep your leg straight. The brace is intended to help keep the soft tissue (muscles, tendons, ligaments) stretched/extended during the lengthening and reduce the likelihood of your joints shortening or hardening.

As the bone is lengthened, the soft tissue benefits from a brace to help maximize stretch. You will have daily exercises to do, but the resting position will be with the knee straight in a brace. There are two main types of surgeries performed:

• Intramedullary (rod inside bone): You can be mobile with the use of crutches or a walker. You may be able to put up to 30 pounds of pressure on the lengthening leg. Your physical therapist will meet with you during your hospital stay for specific instructions, as well as recommended exercises. These exercises are very important for helping to stretch muscles/tendons during the lengthening.
• Extramedullary (rod outside bone but inside the leg): You should plan to be in a wheelchair after surgery. You will not be allowed to put weight on your leg. Your physical therapist will meet with you during your hospital stay and teach you transfers, or how to safely move from bed to wheelchair, as well as recommended exercises. The knee brace is added protection for the extramedullary rod, so it is important to wear as instructed.

No matter with surgery you have, incisions will have dissolvable sutures, steri-strips (wound closure tape) and an occlusive dressing that is meant to keep bacteria and fluids away. No special care is necessary, but it is important to watch for signs/symptoms of infection. The dressings will be removed at the first clinic visit.

You will be taught to use the ERC by your healthcare provider in the hospital. You will notice marker lines on your leg. Use a marking pen to refresh these lines as needed throughout your lengthening. Pay careful attention to how and where to line up the ERC so it is in the correct spot for the magnet to work.

Your surgeon will determine the number of lengthening sessions that is right for you. Each lengthening session only does a fraction of a millimeter and only takes a few minutes. The frequency of lengthening usually varies between 2-8 times per day, depending on which bone is being lengthened, new bone formation, your age, and other factors. The frequency of lengthening may be adjusted throughout treatment by your surgeon.

The length of time you will lengthen is also determined by your surgeon, and depends on your lengthening goal, bone formation, and muscle, tendon, and joint tolerance.

After the initial pain from surgery subsides, most patients report very little to no pain during the lengthening process. Because each lengthening session is only fractions of a millimeter, most patients tolerate it well and report little to no pain. If there is discomfort at times, it is usually controlled with Tylenol. You will go home from the hospital with stronger pain medication and muscle relaxants in case they are needed, but we do not expect you will need to use them. If pain is noted with lengthening, please contact your surgeon.

Your first clinic visit is usually 2 weeks after surgery. You will typically start the lengthening process one to two weeks after surgery, so when you come in for your first clinic visit, you will have already started your lengthening at home.

During the entire lengthening period, clinic visits and x-rays take place every 1-2 weeks so your surgeon can monitor your progress closely. After lengthening is complete, visits and x-rays are every 3-4 weeks while the bone is growing/filling in.

If you live out of state, arrangements may be made for x-rays to be done at home at proper times and sent electronically. You will check in with your surgeon by phone or with a virtual appointment.

You will have physical therapy in the hospital after surgery. You will be taught exercises that are very important to help soft tissues stretch while your bone is getting longer. Complete these exercises daily as instructed. Formal physical therapy appointments during or after the lengthening period are usually not needed.

The PRECICE nail is titanium and does not set off the alarm at the airport.

Instructions for operating your External Remote Control (ERC) are found here.