Humeral Lengthening with the PRECICE Magnetic Lengthening Nail



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.

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  1. 1.

    Accadbled F, Pailhé R, Cavaignac E, Sales de Gauzy J. Bone lengthening using the Fitbone(®) motorized intramedullary nail: The first experience in France. Orthop Traumatol Surg Res. 2016.

  2. 2.

    Al-Sayyad MJ. Taylor spatial frame in the treatment of upper extremity conditions. J Pediatr Orthop 2012; 32: 169–178.

    Article  PubMed  Google Scholar 

  3. 3.

    Babatunde OM, Fragomen AT, Rozbruch SR. Noninvasive quantitative assessment of bone healing after distraction osteogenesis. HSS J. 2010;6(1):71–8.

    Article  PubMed  Google Scholar 

  4. 4.

    Balci HI, Kocaoglu M, Sen C, Eralp L, Batibay SG, Bilsel K. Bilateral humeral lengthening in achondroplasia with unilateral external fixators: is it safe and does it improve daily life? Bone Joint J. 2015;97-B(11):1577–81.

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Beaton DE, Wright JG, Katz JN. Upper Extremity Collaborative Group Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am. 2005 May;87(5):1038–46.

    PubMed  Google Scholar 

  6. 6.

    Belthur MV, Iobst CA, Bor N, Segev E, Eidelman M, Standard SC, Herzenberg JE. Correction of cubitus varus after pediatric supracondylar elbow fracture: alternative method using the Taylor spatial frame. J Pediatr Orthop. 2015.

  7. 7.

    Black SR, Kwon MS, Cherkashin AM, Samchukov ML, Birch JG, Jo CH. Lengthening in congenital femoral deficiency: a comparison of circular external fixation and a motorized intramedullary nail. J Bone Joint Surg Am. 2015;97(17):1432–40.

    Article  PubMed  Google Scholar 

  8. 8.

    Cattaneo R, Catagni MA, Guerreschi F. Applications of the Ilizarov method in the humerus. Lengthenings and nonunions. Hand Clin. 1993;9(4):729–39.

    CAS  PubMed  Google Scholar 

  9. 9.

    Cattaneo R, Villa A, Catagni MA, Bell D. Lengthening of the humerus using the Ilizarov technique. Description of the method and report of 43 cases. Clin Orthop Relat Res. 1990;(250):117–24.

    Google Scholar 

  10. 10.

    Chesworth BM, Hamilton CB, Walton DM, Benoit M, Blake TA, Bredy H, Burns C, Chan L, Frey E, Gillies G, Gravelle T, Ho R, Holmes R, Lavallée RL, MacKinnon M, Merchant AJ, Sherman T, Spears K, Yardley D. Reliability and validity of two versions of the upper extremity functional index. Physiother Can. 2014; 66(3):243–53.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Dal Monte A, Andrisano A, Manfrini M, Zucchi M. Humeral lengthening in hypoplasia of the upper limb. J Pediatr Orthop. 1985;5(2):202–7.

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Damsin JP, Ghanem I. Upper limb lengthening. Hand Clin. 2000;16(4):685–701.

    CAS  PubMed  Google Scholar 

  13. 13.

    Gummesson C, Ward MM, Atroshi I. The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH. BMC Musculoskelet Disord. 2006;7:44.

    Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Herzenberg JE. Humeral lengthening and realignment. In, Rozbruch SR, Ilizarov S eds. Limb Lengthening and Reconstruction Surgery. New York: Informa Healthcare; 2007;ch 39:535–543.

  15. 15.

    Hosny GA. Unilateral humeral lengthening in children and adolescents. J Pediatr Orthop B. 2005;14:439–443.

    Article  PubMed  Google Scholar 

  16. 16.

    Kashiwagi N, Suzuki S, Seto Y, Futami T. Bilateral humeral lengthening in achondroplasia. Clin Orthop Relat Res. 2001;391: 251–257.

    Article  Google Scholar 

  17. 17.

    Katz K, Goldberg I, Bahar A, Yosipovitch Z. Humeral lengthening for septic neonatal growth arrest. J Hand Surg Am. 1989; 14:903–907.

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Kim SJ, Agashe MV, Song SH, Choi HJ, Lee H, Song HR. Comparison between upper and lower limb lengthening in patients with achondroplasia: a retrospective study. J Bone Joint Surg Br. 2012;94(1):128–33.

    Article  PubMed  Google Scholar 

  19. 19.

    Kiss S, Pap K, Vízkelety T, Terebessy T, Balla M, Szoke G. The humerus is the best place for bone lengthening. Int Orthop. 2008;32(3):385–8.

    Article  PubMed  Google Scholar 

  20. 20.

    Kurtz AM, Rozbruch SR. Humerus Lengthening With the PRECICE Internal Lengthening Nail. J Pediatr Orthop. 2017 Feb 27.

  21. 21.

    Lädermann A, Edwards TB, Walch G. Arm lengthening after reverse shoulder arthroplasty: a review. Int Orthop. 2014;38(5):991–1000.

    Article  PubMed  Google Scholar 

  22. 22.

    Lee FY, Schoeb JS, Yu J, Christiansen BD, Dick HM. Operative lengthening of the humerus: indications, benefits, and complications. J Pediatr Orthop. 2005;25:613–616.

    Article  PubMed  Google Scholar 

  23. 23.

    Malot R, Park KW, Song SH, Kwon HN, Song HR. Role of hybrid monolateral fixators in managing humeral length and deformity correction. Acta Orthop. 2013;84(3):280–5.

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    McCarthy JJ, Iobst CA, Rozbruch SR, Sabharwal S, Eismann EA. Limb Lengthening and Reconstruction Society AIM index reliably assesses lower limb deformity. Clin Orthop Relat Res. 2013;471(2):621–7.

    Article  PubMed  Google Scholar 

  25. 25.

    McCarthy JJ, Ranade A, Davidson RS. Pediatric deformity correction using a multiaxial correction fixator. Clin Orthop Relat Res 2008; 466:3011–3017.

    Article  PubMed  PubMed Central  Google Scholar 

  26. 26.

    McLawhorn AS, Sherman SL, Blyakher A, Widmann RF. Humeral lengthening and deformity correction with the multiaxial correction system. J Pediatr Orthop B 2011; 20: 111–116.

    Article  PubMed  Google Scholar 

  27. 27.

    Paley D. PRECICE intramedullary limb lengthening system. Expert Rev Med Devices. 2015;12(3):231–49.

    CAS  Article  PubMed  Google Scholar 

  28. 28.

    Paley D, Herzenberg JE, Bor N. Fixator-assisted nailing of femoral and tibial deformities. Techniques in Orthopaedics. 1997;12(4): 260–275.

    Article  Google Scholar 

  29. 29.

    Pawar AY, McCoy TH Jr, Fragomen AT, Rozbruch SR. Does humeral lengthening with a monolateral frame improve function? Clin Orthop Relat Res. 2013; 471: 277–283.

    Article  PubMed  Google Scholar 

  30. 30.

    Popkov D, Popkov A, Haumont T, Journeau P, Lascombes P. Flexible intramedullary nail use in limb lengthening. J Pediatr Orthop. 2010;30(8):910–8.

    Article  PubMed  Google Scholar 

  31. 31.

    Shabtai L, Specht SC, Standard SC, Herzenberg JE. Internal lengthening device for congenital femoral deficiency and fibular hemimelia. Clin Orthop Relat Res. 2014;472(12):3860–8.

    Article  PubMed  PubMed Central  Google Scholar 

  32. 32.

    Shevtsov VI, Popkov AV, Popkov DA, Yerofeev SA, Prévot J, Lascombes P. Elastic stable intramedullary nailing in Ilizarov bone lengthening. Rev Chir Orthop Reparatrice Appar Mot. 2004;90(5):399–410. French.

    Article  PubMed  Google Scholar 

  33. 33.

    Rozbruch SR, Birch JG, Dahl MT, Herzenberg JE. Motorized intramedullary nail for management of limb-length discrepancy and deformity. J Am Acad Orthop Surg. 2014;22(7):403–9.

    Article  PubMed  Google Scholar 

  34. 34.

    Tellisi N, Ilizarov S, Fragomen AT, Rozbruch SR. Humeral lengthening and deformity correction in Ollier’s disease: distraction osteogenesis with a multiaxial correction frame. J Pediatr Orthop B 2008; 17:152–157.

    Article  PubMed  Google Scholar 

  35. 35.

    Tetsworth K, Krome J, Paley D. Lengthening and deformity correction of the upper extremity by the Ilizarov technique. Orthop Clin North Am. 1991;22(4):689–713.

    CAS  PubMed  Google Scholar 

  36. 36.

    Tiefenboeck TM, Zak L, Wozasek GE. Intramedullary magnetically actuated limb lengthening in a patient with congenital humeral limb shortening. Injury. 2016 Jul;47(7):1597-600

  37. 37.

    Yang CB, Huang SC. Humeral lengthening using the Ilizarov technique. J Formos. Med Assoc. 1997;96(4):291–4.

    CAS  PubMed  Google Scholar 

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Corresponding author

Correspondence to John E. Herzenberg MD.

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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.

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Additional information

Level of Evidence: Level IV

Study performed at Sinai Hospital of Baltimore, Baltimore, MD, USA, and Hospital for Special Surgery, New York, NY, USA.

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Hammouda, A.I., Standard, S.C., Robert Rozbruch, S. et al. Humeral Lengthening with the PRECICE Magnetic Lengthening Nail. HSS Jrnl 13, 217–223 (2017).

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  • humerus
  • intramedullary
  • lengthening
  • PRECICE nail