Precice, Stryde and other intramedullary limb lengthening methods
In this article, we will try to put some light on intramedullary systems, such as Precice nail, Stryde nail and different versions.
History of intramedullary lengthening nails
The first mechanical, motor-driven intramedullary lengthening nail was the Fitbone developed by Rainer Baumgart11 in Germany. It should be noted that a number of intramedullary nails have been developed and applied by other doctors in bone lengthening surgeries. Some of them are Bliskunov nail, Albizzia nail, ISKD and so on. However, these were all mechanical devices that needed to be activated by patients, either by turning the leg at a certain angle, or in some different manner, in order to perform bone distraction. These nails had their own limitations and weak parts.
But Fitbone was a good beginning because the nail could be activated from an external electromagnetic device, which allowed for precision in controls. It still didn’t see much approval.
Precice nail was developed by Nuvasive, it is very similar to Fitbone, i mean the principle is similar. But Fitbone had this weird part sticking out of the device, and it stayed under skin, and patients put the controller on this induction coil to transmit electricity to the nail. Precice uses a little different mechanism, and lacks that induction coil attachment.
Precice device allows both lengthening of the bone and shortening, which is a very important feature. Because in some patients, there might be a need to reverse the lengthening process, if the bone consolidates slowly or there is unbearable pain caused by too much tension.
Last year, in 2019, the latest version of Precice intramedullary nails, called Stryde nail, was released worldwide. The main improvement of Stryde is increased weight bearing capacity. After Stryde surgery, patients are able to walk throughout the procedure. In the first several days or weeks, they may require a support but later it becomes easier to walk.
Precice 2.2/Precice Stryde procedure step by step
After surgery, the hospitalization period is usually around 5-7 days. During this period, all necessary instructions regarding operating the electronic controller to distract bones are given by the doctor or his assistant. First times of bone distraction are done at the hospital. It should be noted that the controller is provided by manufacturer to use in the distraction period, and after the end of bone lengthening, the device needs to be handed in.
When patients leave hospital, they have two options: either they return back home, if they feel good enough and don’t have significant pain. Or, they stay here in Turkey for extended periods, usually around 2-3 months, which is the period of bone lengthening. Since this is the most critical part of the procedure, patients want to feel safer staying closer to the doctor. The optimum rate of bone distraction is 1 mm per day, however this rate may be increased or decreased if the doctor thinks it is needed and gives instructions accordingly. Precice nails allow lengthening the bone up to 8 cm.
It should be noted that in Precice method, patients should not walk or put weight on their legs in any way. Precice nails have very limited weight bearing capability and the internal mechanism can be damaged easily if the patient attempts to stand up or walk. In this case, the nail would need to be replaced by an additional surgery. For this reason, Precice patients have to use a wheelchair to move around, for the entire period of bone distraction. The period of bone lengthening is very similar to other method, and it takes approximately 2-3 months depending on the desired height gain.
If the doctor thinks it is appropriate to implant nails with a relatively larger diameter, then the patient may be allowed to walk with the help of a walker, or possibly without support. However, these are possible for some of the patients, and depends on factors such as bone dimensions and patient weight.
Now the bone distraction has ended, and patients are able to walk once again. In first few weeks, a walker or crutches may be needed. In about 1-1.5 months after the end of lengthening period, patients are mostly able to walk without support and limping. We have to stress the importance of physiotherapy and daily individual exercises in recovery process.
It takes approximately 1-1.5 years for bones to fully heal. After full recovery, the nails can be removed. In Precice method, nail removal is optional. The patient has the choice of having nails removed later, or not removed at all. I should note that the nails are designed in a way that they are suitable to remain inside the bone without causing health problems or corrosion, and they don’t beep at security checks and metal detectors.
With the development of Stryde nail, patients may walk throughout the procedure as long as they are able to.
Advantages of internal methods
Due to lack of external fixation, there is overall less pain and discomfort for the patients. There are no open pin sites which you can see in LON method. The intramedullary nail is placed in to the bone and the cuts are stitched and closed. Which means there is no way for infection to penetrate, and no need to regularly change bandages to avoid infection. When there are no pins and pin sites, there are also less scars after recovery. The scars are almost invisible on most skin types, and they are in form of thin lines. When sleeping or lying on your bed or coach, you feel more comfortable because there are no external fixators that would limit movement.
At the moment, in September 2020, Precice 2.2 method costs 37250 eur and its successor, Precice Stryde method, costs 52250 eur. Compared to fully external methods and LON method, it is definitely much more expensive, but still much cheaper than the same surgery offered in most European and Asian countries as well as USA. For this reason, there are significantly less people who choose fully internal methods for their surgery. The main reason for the high costs is the expensive intramedullary nails used in this method. And material cost makes up a significant portion of the surgery price.
Watch our detailed video about Precice, Stryde and other intramedullary limb lengthening systems: