Methods of Limb Lengthening
Author: Dimitrios Giotikas MD, PhD
Cosmetic stature lengthening is achieved by lengthening the bones, muscles, tendons and nerves of the lower limbs (Thighs or shins or both). Limb lengthening is achieved by applying the principles of Distraction Osteogenesis.
In Athens BJR Centre we implement two methods of distraction osteogenesis for stature lengthening .
- The Precise 2 IM nail
- The Ilizarov circular frame
The Ilizarov frame was introduced by Professor Ilizarov, a bright orthopaedic surgeon from the former Soviet Union. He conceived the concept of circular frame for the management of complex reconstructive treatments in the legs and introduced his device which he called "Ilizarov apparatus" . Although the results with frames have been very good, they weren't without complications. Pin site infection, joint stiffness, difficulties with daily tasks and sleep because of the frame volume are some of the most common.
To overcome these difficulties, a motorized intramedullary nail was introduced by Ellipse Technologies Co (now part of Nuvasive Co). in 2013. Its name was PRECISE-2 and it was the evolution of PRECISE nail which had been introduced by the same company in 2011. The main shortcoming of the PRECISE 2 nail is that it is doesn't permit full weight bearing of the patients until the consolidation of the bone has progressed substantially.
Even so, the reduced device related complications and even some reduced distraction related complications (e.g., axial deviation) have made the PRECISE 2 Nail our first choice in Athens BJR.
We routinely suggest the tibia PRECISE 2 nail when lengthening of the tibia is contemplated. Only in cases where an intramedullary nail is contraindicated (i.e increased risk for pulmonary embolism, patient not deemed compliant for weight bearing restrictions, need for concomitant correction of bone deformity, patient not willing to be restricted in weight bearing) we recommend the use of circular frames.
When lengthening of the femur is contemplated, we prefer the PRECISE-2 nail because the circular frames are not well tolerated in the thigh.