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News Tuesday, February 07, 2017

New technology leads to successful limb lengthening

Florida teen thankful

Walk alongside Tony Futch and you will sense a quiet confidence. He’s ready to take on the world and explore all the wonderful possibilities life has to offer a 16 year old.

“I think I’m going to try baseball,” said Tony, who admits a passion for duck hunting and dirt bikes.

The teenager from the small town of Chipley, about an hour north of the Florida Panhandle, has come a long way in six years. In 2010, a heroic act to prevent his 3-year-old sister, Allie, from falling off a backyard trampoline left him with a broken left femur, the long bone in the leg. The injury, which was three inches above the knee, eventually healed. But it also damaged his growth plate.

“That shut down that end of the bone,” said his father, James Futch.

Tony's uninjured leg kept growing, creating a limb difference. The family sought help from a local physician. “They first wanted to do surgery on the right leg and shut it down,” his dad said. But because Tony was only 10, “we were concerned it would steal a lot of height from him.” The family asked for a second opinion and Shriners Hospitals for Children — Tampa was on the referral list. Futch, recalling how another Shriners Hospitals for Children corrected his uncle’s clubfoot, took his son to the Tampa Shriners Hospital for help.

Futch said he immediately noticed a difference in the quality of care at Shriners Hospitals for Children —Tampa. “From our first visit, they focused on fixing the left leg,” he said. “That’s what we wanted to hear;" however, Tony was still concerned about how conventional methods used to lengthen limbs, would affect his son's abilities.

Maureen Maciel, M.D., a pediatric orthopaedic surgeon, used a new technology called the PRECICE nail to lengthen Tony’s leg. This was less invasive than other methods and allowed him to continue most normal activities.

The PRECICE Nail is a magnetic implant that is surgically placed into one of the bones of the leg to lengthen it. Lengthening occurs when a handheld remote control unit is activated directly over the implant to adjust it. Lengthening sessions typically occur several times each day, in very small increments, until the leg has achieved the prescribed length. The implant holds the bones together until the body makes new bone to fill in the gap. Because everything is contained inside the body, the patient has more freedom.

“Since the patient does not have an external device with pins and wires going into the bone, they can move around more easily and participate in more activities while undergoing the lengthening and healing process,” Dr. Maciel said.

For most children, limb length differences typically are corrected using an external fixator called an Ilizarov apparatus. Named for its inventor, Russian physician Gavriil Abramovich Ilizarov, the device features rings that are fixed to the bone via stainless heavy-gauge wire (called "pins" or Kirschner wires.) The rings are connected to each other with threaded rods attached through adjustable nuts. This is still the primary method used for younger children. Because the PRECICE nail is implanted inside the bone canal, it can be used only in patients who are grown enough for it to fit. Growth plates also must be closed, according to Dr. Maciel. That usually happens about age 13 for girls and 15 for boys.

Dr. Maciel said Tony’s leg discrepancy, which was 5 centimeters, coupled with the fact that his bone was straight enough to accept a nail, made him an “ideal candidate” for the device. He also complied with doctor’s orders and returned for regular follow-up appointments.

Today, Tony’s legs are even, and he soon will be cleared to pursue whatever activities he likes. Futch said he was impressed with the quality of care his son received at the Tampa Shriners hospital. “This is not like any other hospital we’ve ever been to,” he said. “Everyone was genuinely concerned about the well-being of the patients. This was all the way from the medical staff to the people in the lunchroom.”

Dr. Maciel said Tony’s prognosis is excellent. “I expect that he will heal very well and we can proceed with his final surgery to align his knee in the near future.”