Simultaneous Acute Femoral Deformity Correction and Gradual Limb Lengthening Using a Retrograde Femoral Nail: Technique and Clinical Results

J Am Acad Orthop Surg. 2018 Apr 1;26(7):241-250. doi: 10.5435/JAAOS-D-16-00573.


Introduction: Patients with limb-length discrepancies often have concomitant deformity. We describe the outcomes of acute, fixator-assisted deformity correction with gradual lengthening using the retrograde femoral Precice nail (NuVasive).

Methods: We analyzed a retrospective series of 27 patients in whom an external fixator was combined with a Precice nail to correct angular or rotational deformity and limb-length discrepancy. The fixator was applied temporarily to restore normal alignment. The Precice nail was inserted and locked in place to hold the correction, with gradual restoration of limb length.

Results: The 27 patients (mean age, 28 years) had a mean follow-up of 13 months. Secondary deformities were mainly valgus (15 patients) and varus (10 patients). Postoperatively, 93% of patients had correction of limb length to within 3 mm of the discrepancy (mean lengthening, 30 mm). Mechanical axis deviation was corrected to within 8 mm of neutral (ie, zero) in 81% of patients. The mechanical lateral distal femoral angle was corrected to a mean of 88° postoperatively. Final Association for the Study and Application of Methods of Ilizarov (ASAMI)-Paley scores were excellent for 96% of patients.

Discussion: The use of intramedullary lengthening nails has revolutionized the field of limb lengthening. The results of our study show that a retrograde femoral Precice nail can be used safely and accurately to correct both limb-length discrepancy and deformity with minimal complications. The benefits of using this implant include the ability to maintain knee range of motion during the lengthening process. Rapid bone healing allows a relatively fast return to weight-bearing ambulation.

Conclusions: The Precice nail was effectively used to correct both limb-length discrepancy and deformity, with excellent overall outcomes. This surgical technique may help avoid the complications that can occur with prolonged postoperative use of an external fixator.

Level of evidence: Level IV retrospective study.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Bone Lengthening / instrumentation*
  • Bone Lengthening / methods
  • Bone Nails*
  • Female
  • Femur / abnormalities*
  • Femur / surgery*
  • Humans
  • Knee Joint / physiopathology
  • Leg Length Inequality / physiopathology
  • Leg Length Inequality / surgery*
  • Male
  • Middle Aged
  • Range of Motion, Articular
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult