Bone lengthening techniques and post-operative care following Precice surgery

Femoral Bone Lengthening – Surgical Techniques

In the case of the femur, the nail can be inserted in two ways:
Antegrade (classical) method – from above, i.e., from the pelvis toward the knee.

This is the most commonly used method. The surgeon makes small incisions in the skin through which he inserts the nail and performs an osteotomy, which is a controlled cut in the bone.

Fig. Insertion of a nail into the femur using the descending technique—the nail is inserted from the hip side through a 2.5-cm incision. In addition, incisions approximately 0.5 cm long are made through which fixation screws are inserted (two in the upper and lower parts of the nail), and the same incision is made to perform the osteotomy. Near the knee joint, a 2.5 cm incision is made to lengthen the fascia lata.

Alternatively, from the lower part of the femur, i.e., from the knee side. Inserting the nail from the knee toward the hip is called the retrograde method. The illustration below shows how the nail is inserted and the location of the skin incisions and bone cuts (osteotomies). Please note that depending on the insertion technique (antegrade or retrograde), the Precice nail’s magnet is located in a different place. This affects where the patient should place the ERC controller on the thigh. Once turned on and placed against the body in the indicated location, the controller causes the Precice nail to slowly extend.

Lengthening of the tibia and humerus

In the case of the tibia, the Precice nail is almost always inserted from above, i.e., from the knee side.
The illustration below shows the method of nail insertion, the location of the incisions, and the site of the cut in the tibia and fibula (osteotomy), as well as the subsequent lengthening process.
Fig. Insertion of the nail into the tibia from the knee side through a 2.5 cm incision. In addition, incisions approximately 0.5 cm long are made through which fixation screws are inserted (three in the upper and lower parts of the nail). On the medial side, a 0.5 cm incision is made for the tibial osteotomy, while on the lateral side, a 2.5 cm incision is made for the fibular osteotomy.

In the case of the humerus, the nail is inserted from above, that is, from the shoulder toward the elbow.

Post-operative care following limb lengthening surgery

After the Precice nail is implanted, the patient stays in the hospital for 2–3 days. We then recommend that the patient remain in Warsaw for at least the first two weeks after discharge.
During the bone lengthening phase using the ERC controller (the so-called distraction phase), the patient attends follow-up visits at our center every 10–14 days. After this phase ends, the consolidation phase begins, during which the bone heals and remodels. At that time, follow-up visits usually take place once a month—until the bone has fully healed.

Rehabilitation after limb lengthening – physical therapy and occupational therapy

During both phases—distraction and consolidation—physical and occupational therapy are of great importance:
Physical therapy is essential for lower limb lengthening:
Occupational therapy is recommended for upper limb lengthening (e.g., the humerus).
The goal of therapy is to maintain full range of motion—through stretching the muscles, tendons, and ligaments. The attending physician may approve rehabilitation in the patient’s hometown. In some cases, however, specialized treatment available exclusively at our center is necessary—in which case the patient remains in Warsaw for the duration of therapy.
In many cases, custom-fitted orthoses or splints are also used, which are typically prepared during the first week after surgery.

Weight-bearing, mobility, and additional recommendations

Weight-bearing and mobility
The patient must not fully bear weight on the leg containing the Precice nail. The range of permissible weight-bearing is determined by the physician, taking into account the patient’s individual characteristics and the type of nail used.
If both lower limbs are being lengthened, the patient will need to use a wheelchair. Despite mobility limitations, physical therapy must continue—it is a key element of effective treatment.

Note: Dental procedures
Please inform your attending physician of any scheduled dental appointments—both routine and surgical. In some cases, prophylactic antibiotics may be necessary, as the presence of an implant is associated with an increased risk of infection.

Precice Nail Removal

The Precice nail is typically removed about 12 months after surgery, provided that the bone has fully healed.
The procedure is performed on an outpatient basis—the patient does not need to stay overnight in the hospital.