PMC5932753_01
Initial clinical presentation and long leg alignment films demonstrating a 3 cm leg-length discrepancy
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Fig1
She acquired a leg length discrepancy of 30 mm, right shorter than left, had right hip pain, walked with a limp and complained of symptomatic hardware about her hip (Fig. 1).
Post-operative portable films of right femur with PRECICE  nail
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Fig2
She underwent a proximal femoral osteotomy and placement of a 10.7 mm antegrade PRECICE  expandable femoral IMN (Fig. 2).
Long leg weight-bearing plain films demonstrating femur after one week of lengthening
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Fig3
She was followed weekly with physical exams and plain film radiographs (Fig. 3).
Long leg weight-bearing plain films demonstrating femur after four weeks of lengthening
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Fig4
Bilateral long leg Weight-Bearing (WB) plain films demonstrated that the right femur was within 2 mm of length compared to the left femur (Fig. 4) and regenerate was visible in the osteotomy gap.
Long leg weight-bearing plain films demonstrating femur at eight weeks after lengthening with mechanical shortening of nail
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Fig5
Plain films demonstrated a 25 mm leg length discrepancy (Fig. 5).
Enhanced view of distal nail, with a red circle demonstrating flaring of the nail flange that was not present in previous films
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Fig6
Closer inspection of the radiographs revealed that the flange of the nail was flared distally (Fig. 6) and the lengthening mechanism had failed.
Long leg weight-bearing plain films demonstrating femur at ten weeks after restarting lengthening
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Fig7
She continued the protocol and stayed non-WB for the duration of her lengthening, however only an additional 5 mm were gained (Fig. 7) as the mechanism would not lengthen any further, presumably due to the mechanical failure.
Final construct after exchange nailing. Most recent films from January 2016
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Fig8
Her osteotomy went on to nonunion and she eventually underwent exchange nailing (Fig. 8).