Limb Lengthening Techniques Comparison:

Internal Nail (Precice) vs Lengthening Over Nail (LON)

    Limb lengthening procedures have evolved significantly over the years, offering patients the opportunity to address limb length discrepancies and limb lengthening sugery. Two techniques used in limb lengthening surgery are the Internal Nail, specifically the Precice system, and the Lengthening Over Nail (LON) technique (Combined method). 

Internal Nail (Precice 2) System

The Internal Nail, known as Precice, is an advanced limb lengthening device that operates internally within the bone. This system consists of an intramedullary nail that is surgically inserted into the patient's bone and is adjustable through an external remote controller. The Precice system allows for gradual distraction of the bone, promoting new bone growth and ultimately lengthening the limb over time.

Advantages of the Internal Nail (Precice 2)

1. 1.Precise Control: The Precice system offers precise control over the lengthening process, allowing for customization based on the patient's specific needs.
2. 2.Internal Placement: Since the nail is placed internally, it reduces the risk of infections and soft tissue complications compared to external devices.
3. 3.Comfort: Patients often find the Precice system more comfortable than external fixators, enhancing the overall experience during the lengthening process.

Disadvantages of the Internal Nail (Precice 2)

1. 1.Cost: The Precice system can be more expensive compared to traditional external fixators, potentially limiting access for some patients.
2. 2.Limited Weight-Bearing: During the lengthening phase, weight-bearing may be restricted, impacting the patient's mobility and daily activities.

Lengthening Over Nail (LON) Technique

    In contrast, the Lengthening Over Nail (LON) technique involves using an external fixator over an existing intramedullary nail. This method integrates the stability of the nail with the flexibility of the external fixator, offering a unique approach to limb lengthening procedures.

Advantages of the Lengthening Over Nail (LON) Technique:

1. 1.Stability: By combining the internal nail with the external fixator, the LON technique provides stability during the lengthening process, reducing the risk of complications. The patient can bear weight on their legs during the treatment period, allowing the patient to be mobilized.
2. 2.Reduced Surgery Time: Since the intramedullary nail is already in place, the surgery to implement the external fixator for lengthening is typically quicker than traditional methods such as ilizarov technique.
3. 3.Enhanced Healing: The integration of the nail and external fixator can lead to improved bone healing and consolidation post-lengthening.
4. 4.Most importantly, it has reasonable cost compared to other latest systems like PRECICE.
5. 5.Early removal of the fixator allows you to return to regular daily living activities earlier.

Disadvantages of the Lengthening Over Nail (LON) Technique

1. 1.According to the Precise method, having an outside fixator slightly reduces patient comfort.
2. 2.The wound dressing should be changed appropriately and regularly to prevent infection. 
3. 3.Soft Tissue Concerns: The use of an external fixator in addition to the nail can increase the risk of soft tissue complications and discomfort for the patient.
4. 4.Aesthetic Concerns: The visible external fixator in the LON technique may impact the patient's self-esteem during the lengthening phase.

    Both the Internal Nail (Precice) system and the Lengthening Over Nail (LON) technique present unique advantages and disadvantages in the realm of limb lengthening procedures. While the Precice system offers precise control and internal placement benefits, the LON technique provides stability and integration advantages. The choice between these two methods ultimately depends on the patient's specific needs, medical conditions and preferences. As technology continues to advance, further innovations in limb lengthening devices are expected, enhancing treatment outcomes and patient experiences in the future.