{"id":258,"date":"2019-08-02T21:47:28","date_gmt":"2019-08-02T19:47:28","guid":{"rendered":"https:\/\/radler-ortho.com\/?page_id=258"},"modified":"2020-06-25T12:56:44","modified_gmt":"2020-06-25T10:56:44","slug":"verlaengerungsmarknagel","status":"publish","type":"page","link":"https:\/\/radler-ortho.com\/en\/orthopaedische-chirurgie\/verlaengerungsmarknagel\/","title":{"rendered":"Lengthening Nails"},"content":{"rendered":"\n

For different reasons,\nlengthening of a long bone such as the femur (thigh bone) or tibia (shin bone)\ncan become necessary. Shortening of a bone is often the result of a fracture but\ncan be congenital (developing since birth) or idiopathic (present for an unknown\nreason). Additionally, various metabolic and syndromic disorders present with limb-length\ndiscrepancy or severe limb shortening. <\/p>\n\n\n\n

Limb lengthening using an internal lengthening nail (Precice; NuVasive, Inc., San Diego, California, USA<\/a>) entails certain steps. During surgery, the nail is placed within the cavity of the bone and the bone is cut. The nail is fixed to the bone with two screws at the upper end and two screws at the lower end. Approximately 1 week after surgery, the nail is lengthened using magnetic external remote control and the bone is distracted approximately 1 mm per day. This is done at home in four sessions of 0.25 mm of distraction per session. Because the process is so slow, the patient does not usually experience pain. Physical therapy is essential to keep the joints fully flexible and strong. When the desired length is achieved, lengthening is stopped. <\/p>\n\n\n\n

The duration of\ntreatment depends on the amount of lengthening necessary. After lengthening\napproximately 1 mm per day, it takes double to triple that time for the bone to\nheal.<\/p>\n\n\n\n

\n
\n
\"Precice
Phase 1: Insertion of the lengthening nail and osteotomy (bone cut) (red circle) (image: OSS)<\/figcaption><\/figure>\n<\/div>\n\n\n\n
\n
\"Precice
Phase 2: Gradual distraction and new bone formation (image: OSS)<\/figcaption><\/figure>\n<\/div>\n<\/div>\n\n\n\n
\n
\n
\"Precice
Phase 3: New bone consolidates and remodels (image: OSS)<\/figcaption><\/figure>\n<\/div>\n\n\n\n
\n
\"Precice
Phase 4: Bone has completely healed, and nail has been removed (image: OSS)<\/figcaption><\/figure>\n<\/div>\n<\/div>\n\n\n\n

Touch-down partial weight-bearing is possible during the distraction (lengthening) phase of treatment. The newest generation of lengthening nails is especially stable and allows for early full weight-bearing without crutches. The nail is removed approximately 1 year after the end of treatment. <\/p>\n\n\n\n

\"Oberschenkel
Shortened femur (thigh bone) before treatment <\/figcaption><\/figure><\/div>\n\n\n\n
\n
\n
\"Verl\u00e4ngerungsmarknagel
Femur with Precice lengthening nail at end of distraction <\/figcaption><\/figure>\n<\/div>\n\n\n\n
\n
\"Verl\u00e4ngerungsmarknagel
Bone has fully healed around nail and has remodeled; nail can be removed <\/figcaption><\/figure>\n<\/div>\n<\/div>\n\n\n\n

Lengthening nails allow gentle and comfortable correction of limb-length discrepancy and limb shortening. Simultaneous correction of a malalignment<\/a> (bowlegs, knock-knees) is possible using advanced fixator-assisted techniques. <\/p>\n\n\n\n

The use of lengthening\nnails in children is limited by the presence of the growth plate. In the femur\n(thigh bone), lengthening with an intramedullary (IM) nail is possible through\nan approach at the hip from the age of 8 to 10 years. Lengthening of the femur\nusing an approach through the knee and lengthening of the tibia (shin bone) can\nbe done only when the growth plates are closed or nearly closed. The growth\nplates of the femur and tibia usually close at the age of 14 years in girls and\n16 years in boys. If a growth plate has been injured and closed by a fracture\nor infection, nail lengthening is possible. <\/p>\n\n\n\n

In cases of mild\nshortening, it is an option to wait until the growth plates are closed and then\nperform IM nail lengthening. In cases of more severe shortening and limb-length\ndiscrepancy for which waiting is not a good option, lengthening can be\nperformed using external fixation. <\/p>\n\n\n\n

Because of my extensive experience<\/a> with lengthening nails and the high number of cases I treat every year, I can safely and expertly treat even the most complex cases, including congenital and metabolic shortening with and without additional deformities.<\/p>\n","protected":false},"excerpt":{"rendered":"

For different reasons, lengthening of a long bone such as the femur (thigh bone) or tibia (shin bone) can become necessary. Shortening of a bone is often the result of a fracture but can be congenital (developing since birth) or idiopathic (present for an unknown reason). Additionally, various metabolic and syndromic disorders present with limb-length … Continue reading Lengthening Nails<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":18,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"translation":{"provider":"WPGlobus","version":"2.12.2","language":"en","enabled_languages":["de","en"],"languages":{"de":{"title":true,"content":true,"excerpt":false},"en":{"title":true,"content":true,"excerpt":false}}},"amp_enabled":true,"_links":{"self":[{"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/pages\/258"}],"collection":[{"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/comments?post=258"}],"version-history":[{"count":28,"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/pages\/258\/revisions"}],"predecessor-version":[{"id":1243,"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/pages\/258\/revisions\/1243"}],"up":[{"embeddable":true,"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/pages\/18"}],"wp:attachment":[{"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/media?parent=258"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}