LIGHTNING RELEASES (6/1/2014) – Dr. S. Robert Rozbruch, Chief of the Limb Lengthening and Complex Reconstruction Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, and Professor of Clinical Orthopaedic Surgery at Weill Cornell Medical College, Cornell University, New York, NY has been at the forefront of clinical use and design of the internal lengthening apparatus.
Distraction osteogenesis has been used for more than 50 years to address limb-length discrepancy and deformity. Intramedullary fixation has been used in conjunction with external fixation to decrease the time in the external fixator, prevent deformity, and prevent refracture. A new generation of motorized intramedullary nails are now available to treat limb-length discrepancy and deformity. These nails are able to provide bone fragment stabilization and lengthening with reliable remote-controlled mechanisms, obviating the need for external fixation. Motorized intramedullary nails allow accurate, well-controlled distraction, and early clinical results have been excellent. “The accuracy of the Precice Nail (Ellipse Technologies, Irvine, CA) is 99%. We are able to control the rate and rhythm of lengthening with a high degree of precision”, says Rozbruch.
The primary indications for bone lengthening and deformity correction are congenital limb-length discrepancy (LLD) and posttraumatic conditions such as malunion and growth arrest. Achieving the optimal rate and rhythm of distraction is critical to successful distraction osteogenesis, and external fixation has been a reliable tool for this purpose. However, the disadvantages of external fixation frames are well known, including the risk of pin tract infections, skin pain, soft-tissue tethering, and joint stiffness. Bone lengthening with a fully implantable device is desirable to avoid the complications associated with external fixation; however, mechanical integrity and accurate control of distraction are mandatory. The new motorized remote-controlled intramedullary (IM) nails have recently become available and can be used internally to lengthen the femur and tibia. “The patient experience during lengthening with an internal device is substantially better than it was with external fixation”, says Rozbruch. He notes that patients have less pain, more mobility, and faster return to normal life. Rozbruch and his team have performed many such surgeries and have documented their positive results in these two recent publications:
Kirane Y, Fragomen AT, Rozbruch SR: Precision of the Precice Internal Lengthening Nail, Clin Orthop Rel Res. 2014 March 28. Epub Digital Object Identifier (DOI) 10.1007/s11999-014-3575-0.
Rozbruch SR, Birch JG, Dahl MT, Herzenberg JE: Motorized Intramedullary Nail for Treatment of Limb Length Discrepancy, J American Academy of Orthopaedic Surgeons 2014 July.