Use and Safety of the Precice Antegrade Femoral Nail in Pediatric Patients

Abstract

Context: The Precice internal magnetic lengthening nail is used commonly for adult femur lengthening given its accuracy, precise control of lengthening, and patient comfort throughout the process. The nail is not currently approved by the Food and Drug Administration (FDA) for use in children, although many practices continue to use it off label. Aims: We aim to support the notion that the implant is efficient, reliable, and safe for femur lengthening in skeletally immature pediatric patients. Subjects and Methods: We performed a retrospective chart review of all skeletally immature patients who underwent treatment with a precice antegrade femoral nail to help establish the nail's safety and efficiency in this population. Results: We implanted 30 precice antegrade femoral nails (all trochanteric entry) in 25 patients (11 males, 14 females). The average lengthening goal for all surgeries was 47.62 mm (15 mm to 80 mm), and the average length achieved was 47.63 mm (15 mm to 80 mm). Twenty-four out of 25 patients (96%) achieved their lengthening goal within 5 mm. Average distraction rate was 0.97 mm/day (0.75 mm/day to 1 mm/day), and average bone healing index (time to consolidation/cm lengthened) was 19.69 days/cm (13.77 days/cm to 35.33 days/cm). Three patients experienced complications that required additional surgery, including a hip and knee flexor tendon lengthening, guided growth to correct a knee flexion contracture, and bilateral exchange nailing for implant fracture and delayed union. No patients experienced avascular necrosis of the hip, and all complications were ultimately resolved without permanent deficits. Conclusions: The precice antegrade femoral nail can safely and efficiently manage large lower extremity lengthening in skeletally immature children. Concurrent angular or rotational deformity correction was also possible, and postoperative complications were infrequent and manageable.