The old way of lengthening a limb involved wearing a cumbersome frame with six pins that plunged into flesh and bone.
The Precice Nail that Joeli Reim had inserted in her leg has dramatically changed the process, said her surgeon at Seattle Children’s Hospital.
“It’s revolutionized the way we lengthen and expanded the diversity of patients,” said Maryse Bouchard, a pediatric orthopedic surgeon at Children’s.
The Precice Nail device has only been in use since 2011.
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“It’s made the lengthening a much more tolerable and inviting procedure to have when you can do without pins and metal sticking out of your legs for months,” Bouchard said.
Those entry points inevitably became infected, she said. The new system is contained within the body.
Limbs can become shortened from accidents, infections, birth defects and paralytic conditions.
Even some children who broke a leg earlier in life suddenly see a difference in length when puberty hits, Bouchard said.
Many people learn to live with it.
“I have kids come in with a 10 centimeter difference and they’re running around like crazy,” Bouchard said.
“The hardest part is the decision making around it,” Bouchard said. “Who should get it? What type?”
Bouchard doesn’t perform the procedure on anyone with less than a 2 centimeter difference. They also need to be impacted by that difference.
Before the nail is inserted, the bone must first be cut without any heat generation which could kill it.
Growing bone is only the first part.
Muscles and connective tissue must also lengthen to accommodate the longer bone.
Bouchard performs the procedure about once a month. Patients must be 10 years old or older.
“You have to be extremely vigilant,” during all phases of the procedure, she said. Physical therapy is required up to four times a week.
Even then orthopedic problems can arise.
The procedure has been used by dwarves and others of short stature, something Bouchard doesn’t condone given all the problems that can arise.
“That’s a huge risk for very little reward,” she said.