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Intramedullary Limb Lengthening (Magnetic Motorized Nails — PRECICE / FITBONE / STRYDE)

A modern alternative to external fixator (Ilizarov) limb lengthening using a fully implanted magnetically driven telescoping intramedullary nail (PRECICE, FITBONE) that allows controlled gradual distraction from outside the body, eliminating external fixator burden and complications.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

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This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Ortopedi ve Travmatoloji department. Book Appointment →

What is Intramedullary Limb Lengthening (Magnetic Motorized Nails — PRECICE / FITBONE / STRYDE)?

Intramedullary motorized lengthening nails are intramedullary nails with internal telescoping mechanism that lengthen gradually under controlled external magnetic activation (PRECICE — Nuvasive 2011, magnetically driven), implanted electric motor (FITBONE — Wittenstein), or now-recalled cobalt-chromium implant (STRYDE — recalled 2021 due to corrosion at telescoping junction). They represent the major modern alternative to traditional Ilizarov-type external fixator distraction osteogenesis, applying the same biological principle (distraction osteogenesis with regenerate bone formation) but without the external fixator hardware.

Mechanism: nail is implanted via standard intramedullary nailing technique after corticotomy (typically femur, tibia, less commonly humerus); patient or caregiver uses external remote control device (PRECICE) that emits magnetic field rotating the magnet within the nail, which drives the telescoping distraction; distraction rate set at 1 mm per day (4 increments of 0.25 mm) similar to Ilizarov; consolidation phase follows with patient gradually progressing to full weight-bearing; nail is removed once regenerate is fully consolidated (typically 6–12 months from surgery).

Indications: cosmetic limb lengthening (achondroplasia, idiopathic short stature 6–8 cm bilateral femur and tibia lengthening), limb-length discrepancy 2–8 cm in adolescents and adults (after physeal closure), short stature from skeletal dysplasia or other causes, post-traumatic limb shortening; achondroplasia patients can achieve 12–14 cm total height gain through bilateral femoral and tibial lengthening in two stages. Contraindications: open growth plates (relative — pediatric special considerations), inadequate bone diameter (femur < 10 mm, tibia < 9 mm canal), active infection, severe deformity requiring complex correction (Ilizarov hexapod preferred), bone defect requiring transport, severe osteoporosis, MRI-incompatible scenarios (PRECICE has limited 1.5T MRI compatibility, no 3T).

Symptoms

Limb-length discrepancy 2–8 cm causing functional or psychosocial concern
Achondroplasia or other skeletal dysplasia with short stature
Post-traumatic limb shortening with adequate bone quality
Cosmetic concerns about height (idiopathic short stature, careful patient selection required)
Post-pediatric LLD after physeal closure
Pelvic obliquity, gait abnormality from LLD
Failed previous lengthening or unsatisfactory result with external fixator
Patient preference for internal lengthening over external fixator (cosmetic, lifestyle, function)
Adequate bone diameter for nail (femur ≥ 10 mm, tibia ≥ 9 mm canal)
Patient capable of compliance with daily distraction protocol

Risk Factors

Inadequate bone diameter for nail (femur < 10 mm, tibia < 9 mm canal — relative contraindication, may need acute corticotomy with delayed lengthening)
Smoking (impairs regenerate quality)
Diabetes mellitus (impaired healing)
Vitamin D deficiency, malnutrition
Active infection at planned implantation site
Severe limb deformity requiring complex acute correction (Ilizarov preferred)
Significant bone defect requiring transport (no internal nail option)
Open growth plates in skeletally immature patients (special considerations)
Patient non-compliance with daily distraction protocol
Previous intramedullary fixation occupying nail trajectory
MRI-incompatible scenarios (PRECICE has limited 1.5T MRI compatibility)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Limb-length discrepancy 2–8 cm in adolescent or adult
  • Cosmetic concerns about height (consider careful counseling, psychiatric evaluation as needed)
  • Patient interested in internal lengthening (avoid external fixator)
  • Achondroplasia patient considering limb lengthening
  • Post-traumatic short limb requiring reconstruction
  • Failed external fixator lengthening
  • Inadequate bone diameter or other contraindications to internal nail (consider Ilizarov)
  • New pain, decreased lengthening function during distraction (mechanical complication)
  • Sudden change in limb length or alignment during distraction (regenerate failure or hardware malfunction)
  • Concerns about previous STRYDE implant (recall — periodic monitoring recommended)

Treatment Methods

01
Pre-operative evaluation: long-leg standing weight-bearing radiographs (LLD, mechanical axis), CT scanogram for accurate length and bone diameter, MRI to evaluate intramedullary canal and rule out intramedullary lesions, bone diameter measurement (femur isthmus ≥ 10 mm, tibia isthmus ≥ 9 mm), psychological evaluation (especially for cosmetic indications), smoking cessation, vitamin D / nutrition optimization
02
Surgical technique: standard intramedullary nailing technique with corticotomy at planned distraction site (proximal third of femur or tibia for cosmetic lengthening, level dictated by deformity for asymmetry); careful reaming to maintain blood supply; nail size selection (PRECICE diameters 8.5–13.0 mm, lengths 175–315 mm); locking screws applied; postoperative imaging to confirm position
03
Latency phase: 5–7 days post-osteotomy before initiating distraction (callus formation)
04
Distraction phase: 1 mm per day in 4 increments of 0.25 mm; patient or family uses external remote control (PRECICE) to activate magnetic distraction multiple times daily; rate adjusted based on regenerate quality on serial radiographs
05
Range-of-motion physical therapy: aggressive joint mobilization (hip, knee for femoral; knee, ankle for tibial) to prevent contractures (especially knee flexion contracture in femoral lengthening, equinus in tibial lengthening), partial weight-bearing with crutches
06
Imaging surveillance: monthly radiographs to assess regenerate quality, alignment, and consolidation; CT consolidation assessment if uncertain
07
Consolidation phase: after target length, nail maintained for full consolidation (typically 1.5–2 months per cm gained); progressive weight-bearing as consolidation advances
08
Nail removal: outpatient procedure 6–12 months from initial surgery once regenerate fully consolidated; assess gait, range of motion, recovery
09
Special considerations: bilateral simultaneous femoral lengthening for achondroplasia (saves time, allows symmetric gait), staged bilateral lengthening (femora first, tibiae 6–12 months later) for cosmetic short stature, growing rod considerations in pediatric patients with growth remaining
10
Manage complications: pain (analgesics, monitor for compartment syndrome in tibial lengthening), nerve injury (peroneal nerve at proximal tibia — gradual lengthening, immediate evaluation if neurologic change), regenerate failure (consider extended consolidation, autograft, BMP), hardware failure (rare with PRECICE; STRYDE was recalled 2021 due to cobalt-chromium corrosion at telescoping junction; if patient has STRYDE, monitor with MRI for tissue reaction and recommend removal)
11
Long-term follow-up: monitor for refracture (rare with adequate consolidation), residual deformity, joint contracture, asymmetric appearance, return to sports and full function (typically 6–9 months post nail removal); psychological adjustment to body image change

Which Department to Visit?

You can visit our Ortopedi ve Travmatoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.