The PRECICE nail system: The initial Kuwaiti experience

Objectives: The PRECICE system is an implantable limb lengthening intramedullary nail with remotely magnetically controlled distractors indicated for limb length discrepancy (LLD) and short stature treatment. This study reports the initial experience of the Kuwaiti deformity correction unit in utilizing the PRECICE system. Methods: Ten patients (four females and six males) were included in this study. All cases were operated using the PRECICE nail system (five antegrade femoral nails, three retrograde femoral nails, and two tibial nails). All surgeries were performed during January 2019 to February 2020. Results: The mean age of participants was 20 years (12–33 years), with a 21.6 kg/m2 mean body mass index (17–28). LLD etiologies (mean LLD = 39 mm) were congenital (n = 2), developmental (n = 2), post-traumatic non-union (n = 1), post-traumatic malunion (n = 1), post-traumatic physeal arrest (n = 1), and post-deformity correction and lengthening of the contralateral side with circular frame (n = 3). The mean distraction rate was 0.97 mm/day (range: 0.75–1.2 mm/day). Mean lengthening was 39 mm (range: 20–60 mm). Healing was confirmed at 76 days on average (range: 50–120 days). All patients reached full consolidation to regenerate bone, normal alignment, and normal joint orientation. Antegrade femur lengthening was done in five patients. One patient with a previous knee fixed flexion deformity of 25° improved to a 5° lag of extension. No complications were observed during the lengthening procedures. All the patients were followed up for a minimum of 12 months. Conclusion: The PRECICE nail system was successful in lengthening cases with different etiologies, achieving target lengths without complications. All the patients had reported excellent functional outcomes.