At 8 years old in a class to improve her tumbling skills, Sierra Johnson had no idea how much one back flip would impact the next six years of her life. She landed on her tiptoes and wound up fracturing the growth plate in her right leg. She had emergency surgery later that day — the first of five surgeries the now 14-year-old incoming sophomore at Jehovah-Jireh Christian Academy in Baton Rouge has had since 2011.
The bone in Sierra’s right leg stopped growing due to the growth plate fracture. She had a second surgery to place screws in her left knee to slow down the growth in that leg and allow the right one to catch up. When that was unsuccessful, she had a third surgery to remove the screws from her left leg.
“We were concerned because we started seeing her hip alignment change,” said Sierra’s mom, Navonne Johnson. “She had been through so much already, and we were concerned the leg length difference was going to continue getting worse.”
Sierra, a passionate cheerleader and tumbler, was at risk of having to quit performing if her issues were not corrected.
“More than anything, I was worried I wasn’t going to be able to cheer,” Sierra said. “I did my best to stay positive, but it was a little scary not knowing what to expect.”
That’s when Sierra was referred to Brad Culotta, MD, pediatric orthopaedic surgeon with Our Lady of the Lake Children’s Hospital. Thankfully, she was a prime candidate for a new technology and procedure to correct her condition.
The new technology is an expandable intramedullary magnetic nail called a PRECICE nail, and it is used to help children with significant leg length differences. An osteotomy (bone cut) is surgically performed to separate the bone that is short. This magnetic rod is then inserted down the center of the bone across the bone cut. Patients go home with a remote control magnet — and in the comfort of their home, they control the lengthening of their bone daily with this remote.
Patients push a pre-programmed button on the remote a few times each day for a set number of days determined by the doctor. Regular X-ray checkups are performed to monitor lengthening and healing throughout the process. Once the bone has been fully lengthened and healed, the nail is surgically removed about a year later.
The major advantage of the PRECICE nail is that it uses tried-and-true orthopaedic principles with minimally invasive techniques. Bone, once it has been cut, can be lengthened slowly (less than 1mm/day), and the body is tricked into healing the bone at its newly lengthened state. By having this magnetic device inside of the bone, patients now have a convenient and effective solution to control their lengthening prescribed by their doctor.
Dr. Culotta is the only doctor performing this procedure with this device in Baton Rouge and one of only three surgeons in the state of Louisiana. He performed dozens in Atlanta during his specialty training in pediatric orthopaedics in 2012 – 13, but Sierra was his first patient in Baton Rouge using this device for leg lengthening. He has treated numerous other patients here using the same technology device in their growing spine.
The difference in Sierra’s leg lengths was 4.4 centimeters (almost 2 inches), which is a significant difference that could have had a tremendous impact on her future bone and joint health.
“Thankfully, Sierra was sent to me at an age and a time where she didn’t have advanced pain or arthritis in the hip, knee or back from her leg length difference,” said Dr. Culotta. “If you leave that amount of difference untreated, patients will likely develop those problems.”
Sierra was a model patient, even when less than a month after her procedure her home in Central was flooded during the flood of 2016.
“We made sure to get out early because we didn’t want to risk not being able to get out with her remote control lengthening device,” Navonne said. “It was still difficult for her to move around a lot at that point so we didn’t want to have any risks.”
Prior to the device coming to the market in 2012, patients needing to lengthen bones had to use a large, bulky device called an external fixator. While it performed a similar function to the PRECICE nail, it was cumbersome on patients and left them more prone to scarring, stiffness, pain, and difficulty progressing with their rehabilitation. With the PRECICE nail, recovery times are better, scarring and pain minimized, and rehabilitation is much more efficient and effective.
“In medicine and surgery, we’re always looking at what we’re doing now and asking ‘how can we improve or advance our patient outcomes and minimize pain or down time?’” Dr. Culotta said. “This is a great example of that. It also allows for patient participation in the process. They are actively involved in the lengthening and healing, and that makes both the patient and doctor happy.”
A quick glance at Sierra’s before and after X-rays shows how successful this device has been in bringing her legs back to equal length, and her mom credits Dr. Culotta, Our Lady of the Lake Children’s Hospital and the new technology with the success of her daughter’s procedure.
“Dr. Culotta was a Godsend, especially his bedside manner with her,” she said. “You want your children to be comfortable and happy, and he made her feel comfortable from the first visit. We were very much at peace once we met him and went over the procedure. As much as we talk about technology and advancements, I just don’t know where we would be right now without doing it this way.”
Sierra’s dramatic limb-lengthening journey was punctuated with an exclamation point on June 6. She had her final surgery to remove the rod that helped lengthen her bone, and she can continue to cheer and tumble as much as her heart desires.
“Sierra is such a fighter,” her mom explained as she fought back tears. “I can’t wait to see her continue doing what she loves to do. It will be so rewarding.”