Acta Orthopaedica 2014; 85 (3): 293–298 293 How precise is the PRECICE compared to the ISKD in intra- medullary limb lengthening? Reliability and safety in 26 procedures Frank M Schiedel 1 , Björn Vogt 1 , Henning L Tretow 1 , Britta Schuhknecht 2 , Georg Gosheger 2 , Melanie J Horter 1 , and Robert Rödl 1 1Department of Pediatric Orthopedics, Deformity Correction and Foot Surgery; 2Department of Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany. Correspondence: frank.schiedel@uni-muenster.de Submitted 13-08-15. Accepted 14-02-20 Open Access - This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the source is credited. DOI 10.3109/17453674.2014.913955 Background and purpose — The PRECICE intramedullary limb lengthening system uses a new technique with a magnetic rod and a motorized external remote controller (ERC) with rotational magnetic feld. We evaluated the reliability and safety of the PRE- CICE system. Methods — We compared our preliminary results with PRE- CICE in 24 patients (26 nails) with the known diffculties in the use of mechanical lengthening devices such as the ISKD. We used the Paley classifcation for evaluation of problems, obstacles, and complications. Results — 2 nails were primarily without function, and 24/26 nails lengthened over the desired distance. Lengthening desired was 38 mm and lengthening obtained was 37 mm. There were 2 nail breakages, 1 in the welding seam and 1 because of a fall that occurred during consolidation. ERC usage was problematic mostly in patients with femoral lengthening. Adjustment of the ERC was necessary in 10 of 24 cases. 15 cases had implant-associ- ated problems, obstacles were seen in 5 cases, and complications were seen in each of 4 cases. Interpretaion — The reliability of the PRECICE system is comparable to that of other intramedullary lengthening devices such as the ISKD. The motorized external remote controller and its application by the patients is a weak point of the system and needs strict supervision.  Intramedullary limb lengthening nails are used for distraction of long bones, particularly in the leg. The PRECICE system (Ellipse Technologies, Irvine, CA), a new motor-driven lengthening technique, which has CE certifcation and Food and Drugs Administration (FDA) approval, has now been available on the world market for 3 years. The PRECICE system differs in several respects from the mechanical systems that one was previously familiar with, both with regard to its handling and implantation and with regard to its use by the patient for daily lengthening. Another system, the intramedul- lary skeletal kinetic distractor—ISKD (Orthofx International, Verona, Italy)—which is based on a purely mechanical rota- tory system, was introduced by Cole et al. (2001) and after revision in 2012 is still available worldwide. Whereas extensive scientifc data are available for the ISKD (Thonse et al. 2005, Simpson et al. 2009, Burghardt et al. 2011, Kenaway et al. 2011, Papanna et al. 2011, Schiedel et al. 2011, Mahboubian et al. 2012, Wang and Edwards 2012), there have been no reports in the literature on limb lengthen- ing with the PRECICE system. The technique used for length- ening is based on a system of magnetic expansion control (MAGEC) rods used in spinal surgery (Akbarnia et al. 2012, Cheung et al. 2012). An external remote controller (ERC) is required, which causes the magnets that are integrated into the drive thread rod to rotate, making a thinner nail element tele- scope out of a thicker surrounding nail. Descriptions of the mechanism have been published by the manufacturer (Ellipse Inc. 2013) and by Akbarnia et al. (2012). We studied implant-associated diffculties and safety with the PRECICE system and compared our results with pub- lished data on the ISKD system. Patients and methods Between June 2012 and March 2013, 26 PRECICE nails were implanted for lengthening at our hospital. All the patients were included prospectively in accordance with an epidemiological study design, so that the initial results using lengthening with Acta Orthop Downloaded from informahealthcare.com by UB der LMU Muenchen on 06/05/15 For personal use only.