Introduction:
Combined use of cryodestructed bone and vascularized fibula (frozen hotdog) is an effective intercalary biological reconstruction method. However, limb length discrepancy (LLD) is an inevitable complication of limb salvage in the growing child. This paper is aimed at presenting femoral lengthening experience with PRECICE® device in frozen hotdog patients. Patients &

Methods:
Four patients (M/F: 3/1), who underwent primary limb salvage for distal femur osteosarcoma with frozen hotdog technique, were retrospectively reviewed. Mean age was 10,8 (9-13) years and length of resected segment was 195 (150-250) mm at index procedure. Mean limb length discrepancy was 7 (4-10) cm after a mean follow-up of 63 (34- 110) months. Excellent bone healing had been achieved in 3 patients while one of them had chronic nonunion. Results: A mean lengthening of 42 (38-48) mm was performed with subtrochanteric osteotomy using the PRECICE® nail in 3 patients, who showed excellent healing of primary reconstruction. Distraction rate was 1 mm/day and consolidation index was 1,83 months/cm. Distal locking screw was revised in one patient due to osteolysis. One patient underwent nail removal and closed plate fixation due to fracture at the distal end of the nail, after full consolidation. Mean MSTS was 26 (25-27) at the last follow-up. Pre-distracted PRECICE® was used for acute compression of the nonunion site in the fourth patient. However, bone healing could not be achieved after 3 cycles of compression-distraction-observation over an 18-month period. No implant-related complication occurred in any of the four. Conclusion: PRECICE® is effective and reliable for the management of LLD associated with frozen hotdog reconstruction, which involves challenging morphological and biological changes related to recycled bone and hypertrophied fibula. The failure in chronic nonunion case cannot be attributed to the device since it performed the desired compression-distraction effect.