Leg lengthening without external fixation – a new technique

Internal bone lengthening with the Precice magnetically driven intramedullary nail (NuVasive) offers lots of benefits compared to treatment with an external fixator. In the case of complex multi-dimensional misalignments, however, it is no substitute for the correction possibilities offered by a fixator. Nevertheless, in our experience – in both inward and outward bone lengthening – we have found that these two approaches can be combined in a useful way.

This example presents a combination of these techniques that has not been described before. This young girl had a congenital length malformation of the right femur, exhibiting a difference of 5 cm, a bow leg deformity and an outward rotation of the bone. There is also considerable instability of the knee joint due to a lack of cruciate ligaments since birth. If the leg is lengthened, this could lead to the dislocation of the knee joint, which would be virtually impossible to treat.

That is why, in this case, we have lengthened the femur with the Precice nail whilst also correcting the torsion. At the same time, however, we also used a fixator to protect the knee from dislocation and attached a small plate to the growth plate on the femur to guide growth. This meant that the benefits of each of the procedures could be optimally exploited, producing an excellent result and the greatest possible comfort for the patient.

Beinverlängerung mit dem magnetgetriebenen Marknagel vor, während und nach der Behandlung
During the leg lengthening process with the magnetically driven intramedullary nail, the unstable knee joint is «protected» with a ring fixator.
Röntgenbild Knochenverlängerung
The newly formed bone in the area of the lengthened section on the femur is clearly visible.

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