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. 2020 May-Aug;15(2):98-105.
doi: 10.5005/jp-journals-10080-1457.

Regenerate Deformity with the Precice Tibial Nail

Sally Elizabeth Wright  1 , William David Goodier  2 , Peter Calder  2
Affiliations

Regenerate Deformity with the Precice Tibial Nail

Sally Elizabeth Wright et al. Strategies Trauma Limb Reconstr. 2020 May-Aug.

Abstract

Limb lengthening by distraction osteogenesis is an accepted orthopaedic surgical technique. The Precice intramedullary lengthening system is the most recent innovation in limb lengthening. Early results have been favourable in femoral lengthening but there is little reported on the outcome in tibial lengthening. The aim of this study is to present our early results of Precice tibial lengthening, and the stepwise evolution of our surgical technique.

Materials and methods: A case series of 17 consecutive tibial lengthenings were prospectively analysed. Healing index, length achieved, range of motion, and complications were recorded. The initial cases followed the recommended surgical technique. Progressive regenerate deformity during lengthening required changes to the surgical method.

Results: No cases were lost to follow-up. All the nails lengthened at the desired rate. There were no complications of infection or poor regenerate formation. Progressive valgus and procurvatum was prevented in later cases by the positioning of Poller blocking screws at the time of nail insertion.

Conclusion: The tibial Precice nail is successful in obtaining length and good regenerate formation. The recommended technique was insufficient to control the deforming forces from the lower limb muscle compartments during lengthening. We therefore recommend the addition of multiple blocking screws in an amended technique.

How to cite this article: Wright SE, Goodier WD, Calder P. Regenerate Deformity with the Precice Tibial Nail. Strategies Trauma Limb Reconstr 2020;15(2):98-105.

Keywords: Blocking screw; Bone lengthening; Deformity correction; Internal lengthening nail; Intramedullary nail; Limb lengthening; Poller screw; Precice; Tibia; Tibial osteotomy.

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Conflict of interest statement

Source of support: Nil Conflict of interest: None

Figures

Figs 1A to C
Figs 1A to C
Case 7: (A) Long leg radiograph with valgus postoperative mal-alignment; (B) Intraoperative AP intensifier view of CHAOS technique to acutely correct regenerate 4 months after Precice insertion; (C) AP radiograph of trauma nail in situ with corrected alignment immediately post-CHAOS
Figs 2A and B
Figs 2A and B
Case 8. Use of temporary blocking wires intraoperatively: (A) AP intensifier view; (B) Lateral intensifier view
Figs 3A and B
Figs 3A and B
Case 17. Use of permanent blocking screws: (A) Long leg radiograph with AP blocking screws; (B) Lateral radiograph with sagittal blocking screws
See this image and copyright information in PMC

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