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Limb lengthening using intramedullary nail lengthening system

Intramedullary means ‘within the bone’.

An intramedullary nail goes into the bone to align and stabilise the breaks (fractures).

Image of X-ray of leg bone with intramedullary nail inside

The nails we use are either Fitbone or Precice. The surgeon will discuss which one will be the most suitable to use for your child.

They lengthen the bone from the inside, meaning your child will not need an external fixation device with their use of wires and screws.

Fitbone nail

The Fitbone nail is one of the nails that we use to lengthen limbs.

Your child will have an operation to make a surgical break in their bone (osteotomy). During the operation the surgeon will also put in the nail and an electrical receiver.

Image of X-ray of leg bone with nail and Fitbone Control Set (FCS)

Source: Krieg AH, UKBB Basel

The Fitbone nail is controlled using an electronic control unit, which sends energy to a receiver that is placed under the skin. This energy makes the Fitbone nail lengthen, called ‘distraction’. It will slowly make a surgical break larger, making the limb longer.

Once the Fitbone nail is in place you, or you child will lengthen their leg a little bit every day. This is done by the electrical unit called the Fitbone control set (FCS).

Photograph of Fitbone control set

The Fitbone control set (see picture) should be used 3 times per day. It needs to be placed in a specific place on your child’s limb. Your surgeon mark on your child’s limb where the FCS needs to be placed.

Place the Fitbone transmitter onto the limb in the position determined by your surgeon and use the Fitbone control set as instructed. You will be shown how to do this before you go home and how to check the Fitbone nail is working as well. It will take a number of weeks to reach the recommended length.

Precice nail

The Precice nail is the other type of intramedullary nail that is used to lengthen limbs.

These nails have 2 magnets which are moved using a control unit. The movement of the magnets lengthens the bone.

Your child will have an operation to make a surgical break in their bone (osteotomy). During the operation the surgeon will also put in the nail into the bone.

X-ray image of leg showing magnet, gear box, thrust bearing, lead screw and distraction rod

Once the Precice nail is in place you or your child need to lengthen their leg in very small stages every day, using the external remote control (ERC).

Photograph of ERC placed above knee

With the ERC, you or your child can adjust it 3 or 4 times per day to slowly lengthen your limb. It needs to be placed in a specific place on your child’s limb. Your child’s surgeon will show you where it is, or mark on your child’s limb.

With all types of intramedullary lengthening nails, it is extremely important you do your nail lengthening the correct number of times every day. The lengthenings should be evenly spaced throughout day. This will be explained to you before you leave the hospital. You will also get a timetable of when to do your lengthening.

Follow-up after discharge

While the nail is in place, you will need visit your surgeon in the outpatients clinic. Your child will have X-rays taken to monitor the lengthening and bone growth. During the distraction or lengthening phase you will be seen in clinic every 2 weeks.

It is important that your child does any exercises the physiotherapist has given you throughout their treatment. Exercises and careful weight bearing will encourage your child’s new bone to mature and harden. During the early stages of your child’s treatment, they cannot fully weight bear on the limb you are lengthening, and they must use crutches. You will be advised when and how much your child can weight bear.

When your child’s limb has got to the desired length, the intramedullary nail needs to stay in place until new bone grows and hardens. This stage is known as ‘consolidation’.

Once the surgeon has decided your child’s lengthened bone is strong enough they will need another operation to remove the Intramedullary nail. This is usually around 12 to 18 months after it is put in.

Staying healthy during this time

Smoking

Smoking has been scientifically proved to inhibit bone formation. Your child smoke during their nail lengthening treatment. Passive smoking also inhibits bone healing, so do not smoke around your child, and ask others in your home to also not smoke around your child.

Diet

We also recommend a healthy diet, which including vitamin D as it can promote bone healing. You can buy this supplement or multivitamins from many pharmacies or from supermarkets.

Staying strong before the operation

Before your child has their operation, it is important that they build up the muscle strength and movement in their leg. Your physiotherapist will be able to give you a programme of exercises to follow.

Contact us

If you have any questions concerns, please contact the PLRS service on 0114 271 7575, or our physiotherapist on 0114 276 7837.

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Disclaimer

Please note: this is a generic information sheet relating to care at Sheffield Children’s NHS FT. These details may not reflect treatment at other hospitals. This information is not intended as a substitute for professional medical care. Always follow your healthcare professionals’ instructions. If this resource relates to medicines, please read it alongside the medicine manufacturer’s patient information leaflet. If this information has been translated into another language from English, efforts have been made to maintain accuracy, but there may still be some translation errors. If you are unsure about any of the guidance in this resource or have specific questions about how it relates to your child, always ask your healthcare professional for further advice.

Resource number: PLR14

Resource Type: Article

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