Abstract:
BACKGROUND : Lengthening nails (ILN) are an established method of limb reconstruction for leg length
discrepancy (LLD). Literature on these nails is predominantly from developed countries, with more
accessible resources for the procurement of devices and post‑operative therapies. This paper aims to
present the results and lessons learned from four tertiary level limb reconstruction units working within
two middle‑income countries (MIC). METHODS : Ethical approval was obtained from all four units. All
ILN (PRECICE II, NuVasive, USA) undertaken between 2013 and 2020 were included. Demographics,
etiology, surgical approach, and information about the planned versus achieved correction were
compared. Data on time to consolidation and complications were recorded with a 12‑month minimum
follow‑up. Complications were classified according to the Black et al. criteria. RESULTS : Sixty limb
segments lengthened in 56 patients, of which 46 were femora, 12 tibiae and two humeri. Etiology of
LLD was predominately posttraumatic (33%), congenital (26%), and growth plate injuries (22%). Mean
distraction length was 46 mm (20–90 mm). Fifty‑four segments (90%) had <5 mm discrepancy of
planned distraction lengths. Mean healing index was 34.6 days/cm (range: 18–180 days/cm). Thirteen
patients experienced complications, of which ten required further surgery. CONCLUSION : The findings of
our work support the use of intramedullary ILN in MIC with equivalent complication rates and healing
indices compared to the literature. Patient compliance and remote geography were not an issue during
treatment. The lack of access to weekly rehabilitation therapy did not seem to impact the majority of
patients. Reusing nails for extensive LLD cases were safe but should be used with caution.
