In 2011 Dr. Paley, together with Ellipse Technologies, helped develop the PRECICE, a second-generation implantable lengthening nail. Dr. Paley was the first surgeon to use the PRECICE and the results have been excellent. There were some minor shortcomings, however, such as breakages of the nail and breakages of the lengthening mechanism in a few cases. Dr. Paley was the first to identify these problems and he once again worked with Ellipse Technologies to redesign a stronger nail. The improved device is the PRECICE 2. Dr. Paley was the first surgeon to implant the PRECICE 2 for cosmetic lengthening in November 2013. The introduction of the PRECICE nail heralds a new age of cosmetic limb lengthening.
The PRECICE 2
The PRECICE 2 is the most sophisticated lenghtening device available today. The PRECICE 2 has excellent rate control and patients report minimal pain associated with lengthening. The PRECICE is the only device on the market that has a reverse mechanism, which is a very important safety feature. The device lengthens similar to the way an antenna extends. An external remote control (ERC) is used to rotate a magnet inside the nail. This in turn rotates gears which turn a drive screw, which extends the telescopic nail.
The PRECICE 2, spearheaded and developed by Dr. Paley, was designed with the special considerations of the stature lengthening patient in mind. The PRECICE 2 can lengthen up to 8cm for implant diameters of 8.5mm, 10.7mm, and 12.5mm. The PRECICE 2 8.5mm nails were designed for smaller diameter bones, such as those found in children, patients with dwarfism, and more petite adults. The strength of the PRECICE 2 is up to 4 times stronger than PRECICE 1, allowing for increased weight-bearing. Furthermore, the driveshaft connection strength has been increased 3 times more than PRECICE 1, which will reduce the risk of nail mechanism failure when a patient produces too much bone, which can result in premature consolidation, which arrests the lengthening process. In short, the PRECICE 2 permits greater lengthening with a stronger nail, a stronger drive shaft, and a greater range of diameter sizes in order to accommodate patients of all sizes. The PRECICE is currently the only FD-approved device on the market.
Height Gains with PRECICE
Most patients desire 3 inches (7.5 cm) of stature gain and some more than that. The PRECICE 2 can lengthen 8 cm. Patients who desire more length should consider a second lengthening of the other bone. We recommend femurs first and tibias second. The total height gain with two lengthenings is as high as 14.5 cm (8 cm in the femurs and 6.5 cm in the tibias). Greater length is not as well tolerated in the tibia and Dr. Paley highly recommends not to exceed 6.5 cm in the tibias, as it can lead to serious complications. Of course the cost of two lengthenings is twice that of one lengthening. Although the device can lengthen as high as 8 cm, not every patient can safely achieve that much length. We will only allow lengthening to the tolerance of the patient’s bone and soft tissues. We will never sacrifice safety for greater length.
The limiting factor to lengthening is the soft tissues. The risk of complications from lengthening increase dramatically with increased length. Up to 5 cm is a low-risk lengthening. Between 5 and 8 cm is medium risk. Over 8 cm is a high-risk lengthening. If a patient desires 10 cm or more of lengthening, it is much safer to lengthen the femur and the tibia each by 5 cm than to lengthen either bone by 10 cm.
History of Implantable Nails
Limb lengthening techniques have been developed since the early 20th century. The major breakthrough came in the 1950s when Dr. Gavriil Ilizarov developed a series of principles for successful lengthening based on an understanding of the biology of distraction osteogenesis. Since then, many different devices have been developed to improve the lengthening experience for patients. Device evolution is a part of the process, and Dr. Paley has been intimately involved in the development of many lengthening nails over the last three decades. Today, the PRECICE 2 is the most technologically advanced lengthening nail available and the first second-generation implantable nail.
For more information on the PRECICE and the development of internal lengthening nails, please see our Research Paper: Limb Lengthening by Implantable Limb Lengthening Devices