Dec 24, 2011
First North American patient to receive a new
PRECICE Remote Control leg-lengthening device.
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Published: February 1, 2012

A  St. Thomas teenager who suffered a crippling injury as a child is one of the first people in the
United States to benefit from a new remote-control medical device to help him gain back the
length in his injured leg.

Shaqoui Allen, 16, had the new PRECICE remote-control limb lengthening device from Ellipse
Technologies implanted in his left femur - the thigh bone - on Dec. 1 at St. Mary's Medical
Center in West Palm Beach, Fla.

Shaqoui, a freshman at Ivanna Eudora Kean High School, was one of two patients on whom Dr.
Dror Paley performed the procedure on that day, which was the first use of the new device.
The device uses an internal implant that is adjusted remotely from outside the body to lengthen
the bone, according to a statement that St. Mary's Medical Center released. It is used to treat
limb discrepancies - when one limb is shorter than the other.

Shaqoui's left leg was 6.5 centimeters - about two-and-a-half inches - shorter than the right
one, the result of an accident that occurred when he was 11 years old.

Paley, who was a consultant in the development of the device, said that it offers an option that
is less painful, less prone to infection and more precise with the rate of lengthening than other
methods that have been used to make bones longer.

The acciden

Shaqoui was injured during Carnival season.

His mother, Sandrene Allen, had been planning to do laundry and then take her boys to the
Adults' Parade that day, she said. And then, in just a few seconds, life took a drastic turn.

Shaqoui's 4-year-old brother climbed into a golf cart, and Shaqoui went toward the cart to get
his little brother out, Allen said.

The younger child pressed the gas pedal, and the cart lurched forward, hitting Shaqoui, Allen

Shaqoui's leg was broken, and he was in a cast for a long time, Allen said. The family knew that
it was possible that one of his growth plates had been damaged, and that was confirmed when
the cast came off, she said.

Growth plates are areas of developing cartilage near the ends of long bones where bone growth
occurs in children.

Once someone has finished growing, growth plates harden into solid bone.

In Shaqoui's case, the growth plate on his left lower femur - the thigh bone near the knee - was
injured, Paley said.

Because of the nature of the injury to that growth plate, one side of the bone stopped growing
entirely, while the other continued to grow for awhile, Paley said.

The result was that as Shaqoui's right leg continued to grow normally, his left leg grew
asymmetrically for awhile before it stopped growing altogether, Paley said.

So Shaqoui had one leg that was shorter than the other, and the shorter leg was not straight.
"He became knock-kneed," Paley said. "He's got quite a crooked leg."

As Shaqoui grew and the discrepancy became more pronounced, he began to experience
increasing back and neck pain and had to walk on his left toes, he said.

"It was painful - a lot of back pain," he said.

The injury had other effects as well, Allen said.

"In a lot of ways, the relationship between him and his younger brother wasn't 100 percent,"
she said, adding that Shaqoui was going through a lot of pain. "You know how that goes with

Some children also teased her son, she said.

"I think he handled it well, after they understood what the reason was," she said.

The procedure

Looking for a solution, Shaqoui and his mother were told that he would need to have surgery to
lengthen and straighten the leg but that there was no one in the territory who could do it, Allen

They were referred to Paley.

Shaqoui saw Paley and another specialist, but when it came time for the surgery, Shaqoui chose
Paley, Allen said.

Paley, an orthopedic surgeon who specializes in limb lengthening and reconstruction, is the
director of the Paley Institute on the grounds of St. Mary's Medical Center.

He has a worldwide reputation in his specialty and treats children and adults.

The new PRECICE device is a lengthening rod that can be implanted into the marrow of the bone
to lengthen it from the inside, Paley said.

"It's a telescopic rod, so it extends like a car antenna does," he said.

During surgery, the bone is surgically broken in the middle and the rod is implanted into the
bone and attached to the bone at the rod's upper and lower ends, he said.

During daily treatments after surgery, a prescribed amount is dialed into a lengthening
mechanism that is held against the thigh.

A magnet on that mechanism begins to spin around and a corresponding magnet on the
implanted rod causes the rod to slowly extend by the prescribed amount - typically a total of 1
millimeter per day - creating a tiny gap in the spot where the bone is broken.

"The bone is a living substance, so when you break a bone by any means, the bone has a
mechanism to heal itself. It does so by creating new bone to bridge the gap," Paley said.

As the lengthening device slowly extends, the bone builds new tissue, becoming longer.

"If we don't go too fast, the bone can keep up with it," he said.

There is nothing new about lengthening limbs.

Traditional bone-lengthening techniques use an adjustable external fixation system attached to
the leg bone through long-term openings in the skin, according to the hospital. The openings in
the skin can become a route for infection.

The major benefit of the new device, according to the release, is that it gives doctors more
control over the rate of lengthening the limb, in a less-invasive way.

Once the proper length has been attained, Shaqoui will require another surgery to straighten the


Shaqoui currently is an outpatient, going daily to the Paley Limb Lengthening Institute to have
the device in his leg adjusted. He also is undergoing physical therapy and doing special muscle
and joint stretches.

"Dr. Paley, his staff - everyone, the therapists, they're just awesome," Allen said.
Shaqoui will be finished with the lengthening treatments by the end of the week - Friday is his
last day, she said.

By that time, he will have had a total of 65 treatments to extend the bone to the proper length.
Another surgery to remove the device and to straighten the bone will precede a recovery period,
Paley said.

That surgery is scheduled for Feb. 8, and the recovery period will depend on how Shaqoui
progresses with his physical therapy, Allen said.

For the most part, the daily lengthening treatments were not painful, Shaqoui said.

"Now that we're coming to the end of the lengthening, he has some pain down on the lower end
of his leg because his muscles are being pulled. They're being tested," Allen said.

She said that she can already see a big difference.

"I looked at him, and he's standing up. He can't put any pressure on the leg, but before he'd be
leaning up on his side, and he had an 'S' curve on his spine because of how he was standing,"
Allen said. "Now, there's no 'S.' It's just one straight line. I think that is so cool. And no more
waking up early in the morning and telling me his back is hurting. I'm so glad those days are

Being away from home and the rest of the family has been a strain but was well worth it, Allen

Eventually - once he is healed - Shaqoui wants to go back to playing sports.

"He will be able to go back to playing basketball," Allen said. "He loves that. He will be able to go
back to doing all the things he loves to do."

Shaqoui said he is looking forward to getting "back to normal."

"How I'm gonna feel when I walk in the school and nobody in front of me is laughing, watching
me walk and asking me questions?" he said. "It's gonna feel good, because I'll be back to normal.

Direct link to this story
Jan 4, 2012
Dror Paley is First Surgeon in U.S. to Perform Limb
Lengthening with New PRECICE Remote Control
Click Here to read this story
St. Thomas teen
among first to have bone lengthened with new procedure
Limb Lengthening.us
Dror Paley, MD, FRCSC