NICE has been notified about this procedure and it is part of its work programme. The Interventional Procedures Advisory Committee (IPAC) will consider this procedure and NICE will issue an interventional procedures consultation document about its safety and efficacy for 4 weeks’ public consultation. IPAC will then review the consultation document in the light of comments received and produce a final interventional procedures document, which will be considered by NICE before guidance is issued to the NHS in England, Wales, Scotland and Northern Ireland.
 
Status In progress
Process IP
ID number 1770
Description Intramedullary distraction systems are intramedullary devices that are similar to intramedullary nails used for managing fractures. Once inserted and fixed, they can be mechanically lengthened over time using different techniques, resulting in a controlled lengthening of the bone. The device can be inserted into the humerus from the top (antegrade), though this may cause damage to the shoulder muscles, or the lower end (retrograde). Under general anaesthesia, a humeral osteotomy is performed avoiding damage to the periosteum and its blood supply. The adjustable nail-like intramedullary device is then implanted into the intramedullary canal, and the proximal and distal sections of the device are fixed to the appropriate section of the humerus with sterile locking screws. Once implanted and fixed, the length of the device can be adjusted to provide an appropriate amount of compression and allow bony alignment at the osteotomy site. The device exerts a force along the long axis of the bone, which stimulates new bone formation (distraction osteogenesis) in the gap, causing bone lengthening. Over a period of days, weeks or months, sequential distractions are used to produce the target limb length. Different devices achieve distraction in different ways. For example, some work mechanically by releasing a preloaded spring or using a motor driven extension. Others are non-invasive and use an external electromagnetic device.. The intramedullary device remains implanted until bone consolidation is completed. When there is radiological evidence of adequate bone consolidation across the gap, full function and limb use (weight bearing) is permitted. The device can usually be removed using standard surgical techniques or may be left in place indefinitely.

Email enquiries

Timeline

Key events during the development of the guidance:

Date Update
05 October 2021 - 02 November 2021 Interventional procedure consultation

For further information on how we develop guidance, please see our page about NICE interventional procedures guidance