Naika was born with a short leg. The condition is known as congenital femoral deficiency. There are all different levels of severity which affect not only the length of the bone but also the function of the knee and hip. For Naika the issue was not a huge problem when she was a little girl but these short legs stay in proportion meaning that the difference in length between her legs gets bigger as she gets bigger. Now at the age of 17 she has a leg length discrepancy of 3 inches and walks with a significant limp. This is not a common diagnosis but for one reason or another I have attracted quite a number of these challenging cases over the years.
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- Naika before surgery.
Lengthening of bone especially for congenital issues is fraught with complications and not considered a mainstream part of our profession. Fortunately I have had some great mentors and for better or worse have had personal experience with a lot of the complications. As time goes on I have become better at avoiding them. Many times I am faced with scars and complications from previous failed attempts when these cases present. But Naika had never before had the resources to find treatment. This was a good thing.
X-ray showing subtle dysplasia in the R hip needing correction before attempting to lengthen the leg. If this is not performed the forces of lengthening can sometimes dislocate the hip.
I would never wish a congenital deformity on anyone, but I have to admit I was secretly excited about this case. It was a challenging one but not overwhelmingly so. A new implant was developed and became available in 2011 that revolutionized our ability to perform bone lengthening. This magnetically driven distraction rod negates the need for external fixation and is much better tolerated by patients. The price of these implants is about $19,000 and is sometimes difficult to get approved even by US insurance companies.
Thinking about how great it would be to be able to offer this treatment to Naika I sent a quick message with a photo of Naika to my Nuvasive sales rep Al Thomsen in San Diego. He said he would work on it. As good of a guy as Al is I did not get my hopes up. People have busy lives and Haiti is not always on one’s mind when trying to deal with first world problems.
But Al and his company got back to me in 2 weeks and said they would be happy to donate an implant and they would personally deliver it and participate in the case just as if we were at LLU!
The case was scheduled and airline tickets were purchased. Al did not waver when reading news reports about civil unrest and fiery protests in Port au Prince.
Since I have become the “go to” for any piece of broken equipment at HAH, two days before Al’s trip, I was faced with the need to replace a unique 1/2’’ copper union on our central oxygen system. This is a bit beyond what you would expect to find at Home Depot, but I called to see if Al could source the part. I followed with a text a few minutes later asking him to warn me when he was going to the store so I could be available for trouble shooting. He said he was already at the plumbing store. This was only 10 min after I had made the cold call request!
Anonymous good Samaritan plumber in southern California sweats essential copper joint.
They did not have quite the right part so he went to another place and found it. But the pieces needed to be sweated together by a professional plumber. Five minutes after that he texted me that he met a plumber in the parking lot who donated his services on the back of his mobile plumbing truck and got the job done.
Al and Craig Decker from Nuvasive arrived well, minus the implants that were placed in a suitcase that went missing at the Port au Prince airport. Fortunately that situation got resolved, albeit with a bit of stress. The case went well. I won’t bore you with the details but if you are interested I previously published a short YouTube video of the Precice® Nail Surgical Technique. The plumbing part also fit perfectly and for the first time in 4 months our oxygen system was back up and running. I also found out that Al is an experienced electrician and he was able to help me install and fix a lot of other stuff.
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- Central O2 system distributes oxygen at 50psi to our 3 operating rooms and recovery room.
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- The nail is locked with screws at the top and bottom and then the bone is distracted through the crack that is made at the time of surgery. New bone fills in the gap.
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- Inside of the Precice® Nail.
A big part of the success of limb lengthening cases lies in proper physical therapy. In fact this is so important that at Loma Linda University many of our patients who are coming from distant locations to have this surgery performed are required to stay in town for 1-3 months during the lengthening process.
Al Thomsen multi-talented Nuvasive sales rep fixes scrub sink faucet.
At HAH it is wonderful to have Dr. Irma Henry who trained at LLU and her capable team provide this same high level of rehab service. Naika is enrolled in PT 5x per week and working hard to maintain knee and hip motion in order to have the best result possible.
For Naika this is like a miracle. Many of us wonder why “miracles” don’t seem to happen like they did in Bible times, but I would argue that they actually do. Jesus commissioned the disciples to go out, proclaim the kingdom of God and perform miracles in His name. Today, those of us who were born with resources, and educated in the health care profession have a similar commission. To Naika, this is a miracle. Yes maybe we do understand how that magnetic gear works, and even atheists could perform the operation, but the miracle of new bone filling in the gap and building strength with time is not something that any of us can take credit for. Watch for follow up images of this modern day miracle in future posts.
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- Irma introduces Naika to the external remote control. This device is placed on a specific location on her thigh for about 7 minutes each day (divided into 3 sessions). Two large magnets on the external device force the internal magnet in the nail to spin 210 times for each millimeter of lengthening. The process is painless and performed in the comfort of her home.
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- X-ray at 2 week follow up showing distraction with a light cloud of bone in the gap.
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I know CFD well. I’ll be explaining to a PCP dr. tomorrow. Rod Looks very familiar. I was wondering if you could use Precice rods in Haiti.
Miraculous and exciting! God bless the team at HAH and Naika.
This is fantastic! My Haitian born son had a successful limb lengthening surgery in the states. I’m glad to know others still in Haiti have access to this now. It’s life changing! Blessings to all