It was performed on Anschua Botha (31), who was left with one leg shorter than the other because of a motor vehicle accident in 2007.
"This is the first time that this revolutionising surgery, which involves inserting a fully controllable nail to lengthen a patient's leg instead of an external fixator, was attempted on our continent," says Birkholtz.
"In the past, when patients suffered from dwarfism, or one of their legs were shorter than the other due to infection, trauma or a growth disturbance, we had to use external fixators to lengthen the limb. This meant that pins had to be inserted on the outside of the skin, which could cause infection. With this new procedure, the nail is fully implantable."
Botha, who started experiencing back, knee and hip pains due to her one leg being shorter than the other, did undergo the external fixator procedure in 2007 as this was her only option at the time, but says that she struggled with the bulkiness of the device and getting dressed.
A Precice intramedullary nail, developed by Ellipse Technologies, was used for the groundbreaking limb lengthening procedure. The nail can be non-invasively lengthened in the orthopaedic surgeon's rooms or by the patient at home using a magnet remote controller. Dr Birkholtz became aware of the intramedullary nail last year, while developing his own device.
"Instead of reinventing the wheel I decided to set up a meeting with Bart Balkman, VP orthopaedics, global sales and marketing at Ellipse Technologies, which developed the technology and met with him at the Brazilian Congress of Orthopaedics and Traumatology in 2012.
"After our discussion he agreed to allow us to use the technology in South Africa, as he saw it as a new market." Both Frits Potgieter, the orthopaedics sales executive of 3rd Age Surgical, which distributes the technology in South Africa and Balkman were present at the operation that took place on Wednesday 15 May 2013.
Dr Birkholtz says the procedure to insert the nail into the bone takes about two hours, and the patient recovers for a week after which the stretching of the bone begins. "Every day the magnet is used to extend the nail by a millimetre until the required length is reached, so if you need to lengthen the limb by 30 mm that will take 30 days."
Netcare Unitas Hospital's general manager, Adélle Johnstone, praised the doctors and staff for their pioneering spirit. "By keeping abreast of the latest medical advancements in their field of expertise they are able to offer patients world class quality care," she says.
Dr Franz Birkholtz is an orthopaedic surgeon with a special interest in trauma and limb reconstruction. He is considered a world authority in the field of circular fixators. His practice in Pretoria has been recognised as an international centre for training in external fixation and limb reconstruction techniques.
Limb reconstruction involves deformity correction, treatment of non-unions, mal-unions and severe bone infections with specialised techniques often involving special fixation devices such as mono-lateral or circular fixators that are put around the bone.
The Walk-A-Mile Centre of excellence at Netcare Unitas Hospital comprises a multi-disciplinary team dedicated to quality care for patients requiring these highly specialised procedures.
