Acute deformity correction and lengthening using the PRECICE magnetic intramedullary lengthening nail

Background: External fixators have been used to treat patients with limb length discrepancy with deformity. Implantable intramedullary (IM) lengthening nails are an attractive alternative achieving accurate results with fewer complications than external fixators. We report on PRECICE™ nail utilization for simultaneous lower limb lengthening and acute deformity correction. Materials and Methods: A retrospective institutional study included a total of 22 segments (13 femurs, 9 tibias; mean age = 17 years) that underwent simultaneous acute deformity correction and lengthening using fixator-assisted nailing and the PRECICE™ IM nail between 2012 and 2015. Results: All segments were corrected with mean final mechanical axis deviation 0.8 cm (0–2.0 cm). Femoral segments achieved frontal plane correction from a preoperative mean lateral distal-femoral angle of 86° to a postoperative mean of 89°; and a sagittal plane correction from a preoperative mean posterior distal femoral angle of 76° to a postoperative mean of 84°. Tibial segments achieved frontal plane correction from a preoperative mean medial proximal tibial angle of 94° to a postoperative mean of 89°; and a sagittal plane correction from a preoperative mean posterior proximal tibial angle of 72° to a postoperative mean of 79°. Rotational malalignment was corrected in all cases based on clinical examination of the rotational profile. The mean length achieved was 4.7 cm. One femoral segment (4.5%) did not achieve the lengthening goal. The mean consolidation index was 42 days/cm. Mean distraction index was 0.7 days/mm. Conclusions: Internal lengthening can permit both lengthening and acute deformity correction, with appropriate preoperative planning, using fixator assisted nailing techniques.