The nails used in limb lengthening surgery with the Precice 2 method are made of a titanium alloy known for its high strength and durability. This advanced and highly safe system allows the bones to lengthen in a controlled manner. The nails are implanted inside the bone, while the lengthening process is managed externally with the help of an External Remote Controller (ERC). By activating the magnets within the nail, the ERC enables a gradual extension of approximately 1 mm per day, ensuring both precision and safety throughout the treatment.

Mechanism of Magnetic Control
The key feature of the Precice 2 nail is its magnetic control system, which allows gradual bone lengthening through an external remote controller. Thanks to this innovation, patients can easily manage the lengthening process in their daily lives with comfort and precision.

Sensitive Lengthening
The daily lengthening rate can be adjusted according to the patient’s level of pain and bone consolidation. This flexibility not only ensures proper bone healing but also allows the surrounding muscles and nerves to adapt gradually to the extension, reducing complications and discomfort.

High Resistance
Made of a biocompatible titanium alloy, the nail is highly durable and designed to remain safely inside the body for an extended period. Its advanced material minimizes the risk of allergic reactions, ensuring both long-term reliability and patient safety.

The system is designed to gradually extend the nail implanted inside the bone. The External Remote Controller (ERC) safely and precisely manages the nail through its magnetic mechanism. By activating the internal magnets, the ERC enables a controlled daily extension of approximately 0.99 mm. This gradual process stimulates the formation of new bone tissue, allowing the bone to lengthen in a healthy and natural way. The ERC is specifically designed for ease of use, so patients can comfortably perform the lengthening process at home or within their daily routines.

The Precice 2 nail is a technologically advanced internal fixation system used in limb lengthening surgeries. Manufactured from a titanium alloy, it offers both high strength and excellent biocompatibility with body tissues, allowing it to remain safely in the body for long periods without issues. The size of the nail is carefully selected according to the patient’s bone structure, typically available in 8.5 mm, 10.7 mm, 11.5 mm, and 12.5 mm diameters. The surgeon evaluates the patient’s X-rays to determine the most appropriate size based on bone thickness and anatomy.

During the procedure, the intramedullary nail is surgically implanted inside the bone. This placement ensures that the lengthening process continues in a stable and safe manner while preserving the bone’s strength. Thanks to its lightweight yet durable titanium structure, the nail not only supports comfortable daily activities but also minimizes the risk of complications by enabling a smooth and controlled lengthening process within the bone.

In the video below, you can follow the post-operative journey of our Russian patient who underwent limb lengthening surgery with the Precice method. The Precice system includes a remote controller that enables precise adjustments to the internal nail.

In this case, when an over-lengthening was identified in one leg, the controller was switched to reverse mode. This allowed the nail to retract, effectively correcting the discrepancy and restoring balance.

One of the key advantages of the Precice system is its ability to provide immediate intervention in such situations. By holding the controller in reverse, the nail moves in the opposite direction, making it possible to achieve safe, controlled shortening whenever necessary.

Important Information
Patients weighing between 40–70 kg may be able to walk with the support of a walker, depending on the nail size and always under the supervision of their doctor. However, it is extremely important not to place excessive weight on the nail. Walking is therefore limited to controlled activities such as physiotherapy sessions, visits to the toilet, or short walking exercises.

Outside of these controlled movements, the use of a wheelchair is mandatory throughout the lengthening process. This precaution is vital, as putting too much pressure on the legs can damage the nail’s mechanism. In addition, since the newly forming bone tissue is not yet strong enough, overloading may compromise bone quality and put the overall treatment at risk.

If the Precice method is chosen for the lengthening surgery, there will be two surgeries conducted.

Limb Lengthening Surgery / Preparation
Before the operation, the patient’s general health condition is evaluated, and necessary X-rays are taken. Based on these assessments, the most suitable nail size is determined in accordance with the patient’s bone structure and lengthening goals.

Surgical Placement
The surgery is performed under anesthesia. A controlled cut is made on the bone surface to create space for the lengthening process. The previously selected Precice 2 nail is then carefully placed inside the bone and securely fixed.

Controlling the Nail with the Remote Controller
After the operation, the recovery and lengthening process begins simultaneously. While the bone tissue is healing, patients gradually extend the nail using the External Remote Controller (ERC). The standard protocol is 0.99 mm per day, achieved in three sessions of 0.33 mm each.

Recovery and Monitoring Process
During this stage, scar care and medication follow-up are provided, and regular X-rays are taken to monitor bone healing and consolidation. Consistent physiotherapy is essential to help the muscles and joints adapt to the lengthening, ensuring mobility and reducing complications. This approach allows patients to safely and smoothly return to their daily and social lives. Once the bone has fully consolidated, the doctor usually recommends removing the magnetic nail.

Removal of the Intramedullary Nail
When bone union is complete, and with the doctor’s recommendation as well as the patient’s request, the intramedullary nail is surgically removed. This procedure typically takes 2 to 2.5 hours. For the first two weeks after removal, patients walk with assistance to avoid strain. After this short period, they can return to their normal routines without limitations.

Minimally Invasive System
Since no external fixators are used, the risk of infection or skin irritation is significantly reduced. The nail is placed directly inside the bone, leaving no visible scars and ensuring a more comfortable recovery process.

Comfortable and Low-Risk Recovery
With the nail securely positioned inside the bone, the Precice 2 method minimizes pain and supports faster recovery. Because the lengthening is gradual and controlled, the muscles, nerves, and connective tissues can adapt smoothly, reducing complications.

Dual Application
The Precice 2 nail can be safely used in both the femur (upper leg) and the tibia (lower leg), offering flexibility for patients with different height-increase goals.

High Safety
Made of biocompatible titanium alloy, the Precice 2 nail can remain inside the body for long periods without issues. Its carefully engineered internal design ensures durability and long-term resistance to damage.

Adaptable to Daily Life
During the lengthening process, patients can use a wheelchair or walker. For those within the appropriate weight range, short-distance walking is also possible, making the overall process easier and more manageable.

Low Risk of Infection
Since there are no external fixators, patients are free to take showers whenever they wish, and the risks of infection or complications are very low. For this reason, the Precice 2 method stands out as one of the safest and most comfortable options in limb lengthening.

High Cost
The Precice 2 method is more expensive than other lengthening techniques due to the advanced technology it uses and the comfort it provides. This higher cost may pose an economic challenge for some patients.

Limited Weight-Bearing
The nail has a limited weight-bearing capacity. Patients must restrict their activities and avoid putting excessive pressure on the legs. As a result, the use of a wheelchair or walker is mandatory during the lengthening process.

Second Surgery Required
Once the lengthening and recovery are complete, a second surgery is necessary to remove the intramedullary nail. Although this procedure is relatively short, it still requires a recovery period.

Limited Lengthening Capacity
The nail’s maximum capacity is 8 cm. Therefore, a single surgery can provide up to 7–8 cm of lengthening. Patients seeking greater height gain would need additional surgeries, which extend the recovery period and increase costs.

Risks and Complications
Although the Precice method is minimally invasive, it still carries risks such as bone nonunion, infection, or pain. Rare complications include bending of the nail or delayed bone consolidation.

Device Malfunction
Despite its advanced magnetic technology, there is still a possibility of device malfunction. In such cases, additional interventions may be required, which could prolong the recovery process.

Psychological Effects
The long treatment duration and restrictions on movement can affect patients mentally. The recovery process may sometimes cause stress, decreased motivation, or emotional difficulties.

Requirement of Expertise
The Precice 2 method requires advanced surgical expertise and in-depth knowledge of the device. Not every orthopedic surgeon is qualified to perform this procedure, and undergoing surgery with an inexperienced doctor may increase the risk of complications.

Comfortable Recovery Process
Since there are no external fixators, the Precice 2 method provides greater comfort and leaves no visible scars on the skin. This feature makes it easier for patients to adapt to their daily lives during the recovery process.

Minimal Risk of Infection
As a fully internal fixation system, the Precice 2 method carries a much lower risk of infection compared to external fixator methods. This represents a significant advantage for patients who want to minimize potential complications.

Aesthetic Benefits
Because the nail is placed inside the bone, there are no external devices visible on the body. This aesthetic advantage makes Precice 2 a preferred choice for patients who wish to avoid noticeable scars or skin marks.

Reduced Psychological Stress
Unlike external fixators, which can cause aesthetic concerns and stress during long recovery periods, the Precice 2 method eliminates these issues. With internal fixation, patients experience less anxiety and can move through the recovery process with greater confidence and peace of mind.