Orthopaedic surgeons at the MQ Health Limb Reconstruction Centre have performed a revolutionary new limb lengthening procedure using minimally invasive technology that replaces the need for external fixation.

Associate Professor Munjed Al Muderis and Dr Kevin Tetsworth have performed an Australian first limb lengthening surgery using the minimally invasive Precice® Bone Transport System. The innovative technology is used to treat segmental bone defects of up to 10 centimeters in the tibia and femur that have resulted from a tumour or injury.

The Precice® Bone Transport System works by using the body’s own capacity to create new bone as well as surrounding soft tissues, ligaments, blood vessels and nerves. It is currently the only all-internal system, compared to traditional external fixation systems that require patients to wear an external device for an extended period of time, with the potential for increased pain and risk of infection.

The process begins withan osteotomy in which the orthopaedic surgeon cuts the bone to be lengthened. Segments of bone related to the fracture or the tumour are then removed and a component of intercalary bone to be transported is created.

An implantable, magnetic intramedullary nail with a dual slot supports the transport of the bone segment to facilitate healthy regeneration.

Following implantation, an external remote controller is used to precisely move the bone segment up to 10 centimeters, with multiple configurations and size options available to best match each patient’s unique anatomy.

Continued growth of the new bone is accomplished by adjusting pins in the frame four times a day, ¼ millimetre with each adjustment, for a total of 1 millimetre a day with the body continuously producing new tissue in the gap until the desired length of bone has been generated.

Patient Jim Medcraft, who underwent the procedure in June this year, was enormously grateful that he was able to benefit from the surgery.

Jim was severely injured by a hit and run accident while working in Texas in 2016 and, in addition to a subdural haemorrhage, fractured spine and other serious injuries, Jim broke both the tibia and fibula of both legs. He’s had many operations since that day, but the possibility of losing one of his legs was devastating news.

“Prior to meeting Munjed, I was told that my leg would need to be amputated,” he said.

“While my right leg had healed well after the initial surgeries, my left leg didn’t, leaving a gap in the bone too large for standard surgical limb lengthening techniques.

“I also contracted a golden staph infection, which worsened the nerve damage

I had and led to other complications. After I was told amputation was the only option, I went to see Munjed to discuss osseointegration.

That’s when he said that the leg was not at the point of amputation and could be fixed.

“There are no words to describe how I felt when I found out there was a chance the leg could be saved. It’s been four weeks now since the limb lengthening procedure and the leg has already grown.

“I think it’s pretty amazing to see such an ancient practice like medicine use new engineering technologies to develop this innovative procedure that can have such a huge impact on the lives of patients and their families.”

Associate Professor Al Muderis said that segmental bone defect poses a major challenge for reconstructive surgeons.

“Treatment options are very limited, utilising the application of external fixators for a lengthy time and extending to months or even years or, alternatively, an amputation,” he said.

“This new technology revolutionises segmental bone defect treatment by utilising keyhole surgery to fill the gap without the need for external devices, allowing the patient larger freedom of movement and comfort.”

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