HSS Journal ®

, Volume 13, Issue 3, pp 217–223 | Cite as

Humeral Lengthening with the PRECICE Magnetic Lengthening Nail

  • Ahmed I. Hammouda
  • Shawn C. Standard
  • S. Robert Rozbruch
  • John E. Herzenberg
Original Article



Different types of external fixators have been used for humeral lengthening with successful outcomes reported in literature. Motorized intramedullary (IM) lengthening nails have been developed as an alternative to external fixators for long bone lengthening in the lower extremity.


This case series reports on using the new technology of IM lengthening nails for humeral lengthening. We assessed the radiological healing and functional outcomes after using the PRECICE IM nail for humeral lengthening.


This multicenter retrospective study included a total of six humeri in five patients (mean age was 20 years) that underwent lengthening with the magnetic IM PRECICE nail in two centers in the USA. The etiology was humeral growth arrest post-bone cyst (two segments), post-septic growth arrest (two segments), and multiple hereditary exostosis (bilateral segments in one patient). The outcomes measured were the length achieved, distraction index (DI; the length achieved in mm divided by the duration of lengthening in days), consolidation index (CI; number of days from surgery until consolidation divided by the length of the regenerate in cm), complications encountered, and functional outcomes (shoulder and elbow range of motion, the upper extremity functional index (UEFI), and QuickDASH functional scores).


The mean follow-up period was 1.8 years (0.9 to 2.4 years). All segments achieved the goal of lengthening; the mean was 5.1 cm (4.5 to 5.8 cm). Mean DI was 0.7 mm/day (0.5 to 0.8). Mean CI was 36 days/cm (25 to 45 days/cm). No complications were observed. At the last follow-up, all patients maintained their preoperative range of motion (ROM) except one patient had reduced shoulder ROM. QuickDASH score and upper extremity functional index showed postoperative improvement compared to the preoperative scores.


IM lengthening nails can provide successful and safe humeral lengthening. Specifically, the PRECICE nail has accurate control over the lengthening process.


humerus intramedullary lengthening PRECICE nail 


Compliance with Ethical Standards

Conflict of Interest

Ahmed I. Hammouda, MD, has declared that he has no conflict of interest. Shawn C. Standard, MD, reports grants from NuVasive Specialized Orthopedics, during the conduct of the study; personal fees from NuVasive Specialized Orthopedics and Pega Medical; grants from CS Medical Supply, Metro Prosthetics, and Stryker; grants from Baxter, DePuy Synthes, Merete Technologies, MHE Coalition, NuVasive Specialized Orthopedics, Orthofix, OrthoPediatrics, Smith & Nephew, Stryker, and Zimmer Biomet, outside the work. S. Robert Rozbruch, MD, reports personal fees from Smith and Nephew, Stryker, NuVasive, outside the work. John E. Herzenberg, MD reports grants from NuVasive Specialized Orthopedics, during the conduct of the study; personal fees from Orthofix; grants from OrthoPediatrics, NuVasive Specialized Orthopedics, Smith & Nephew, CS Medical Supply, Metro Prosthetics, and Stryker, Baxter, DePuy Synthes, Merete Technologies, MHE Coalition, NuVasive Specialized Orthopedics, Orthofix, OrthoPediatrics, Smith & Nephew, Stryker, and Zimmer Biomet, outside the work.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Informed Consent

Informed consent was obtained from all patients for being included in the study.

Required Author Forms

Disclosure forms provided by the authors are available with the online version of this article.

Supplementary material

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Copyright information

© Hospital for Special Surgery 2017

Authors and Affiliations

  • Ahmed I. Hammouda
    • 1
    • 2
  • Shawn C. Standard
    • 1
  • S. Robert Rozbruch
    • 3
  • John E. Herzenberg
    • 1
  1. 1.International Center for Limb Lengthening,Rubin Institute for Advanced Orthopedics,Sinai Hospital of BaltimoreBaltimoreUSA
  2. 2.Department of Orthopaedic SurgeryAl-Azhar UniversityCairoEgypt
  3. 3.Hospital for Special SurgeryNew YorkUSA

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