Limb Lengthening Surgery
Limb lengthening is a specialized surgery used to restore limb length
, which should only be performed by a surgeon with experience in limb lengthening. Limb lengthening is distraction ostegenesis, also called callus distraction
There are four phases in Limb lengthening procedure,
" Preparation
"Surgery
" Lengthening
"Strengthening.
But the important two phases are distraction phase and Consolidation phase.
1. Preparation
" X-Rays are taken of the legs
* Psychological evaluation to ensure that the patient will be able to endure the entire procedure, with the necessary positive attitude.
2.Surgery
In this limb lengthening operation, bone and soft tissue regenerate when they pulled apart at a very slow rate of approximately 1 mm per day. If the rate of distraction is faster than this, bone may fail to form between the two ends of the bone that are being pulled apart and soft tissues, such as muscle, may experience contracture (get too tight) or nerves may become paralyzed. In the most common procedure, the tibia and fibula bones of both lower legs are broken and an external fixator device is attached to each half of each severed bone. The device is attached to the bones using pins or wires that go through small holes drilled through the patient's skin.
3.Lengthening
Lengthening is also called distraction. This phase begins about a week after surgery and continues over the next two to three months, depending on how much lengthening is desired. The fixator device is lengthened, increasing the distance between both halves of each bone. New bone growth occurs in the space in between. The lengthening is applied slowly, about 1mm a day. Typically a screw is turned four times a day to achieve the 1mm per day separation. External fixator devices may also be motorized to achieve continuous lengthening throughout the process. Patients should be scheduled for one to two hours of therapy each day during lengthening. By the end of this phase, the lower legs have been increased two to three inches. The patient is generally confined to a wheelchair during the Lengthening phase and must not bear any weight on the growing bone.
4.Strengthening
Strengthening phase may also be called the Consolidation phase. For the following three to six months, the patient continues to use a wheelchair until the newly grown bone is strong enough to bear the patient's weight. The external fixator device continues to be used to keep the two bones properly aligned, but is no longer lengthened. During bone strengthening, physical therapy can be reduced to three times a week. At the end of the Strengthening phase, a simple operation is performed to remove the external fixator device, and the patients can usually walk on theirown, no longer needing a wheelchair. However, they may require a cast for an additional month for protection of the legs.
The patient is generally confined to a wheelchair during the Lengthening phase and must not bear any weight on the growing bone.
Candidates for Limb Lengthening & Deformity Correction Surgery:
"Adults and Children
"Arm or leg length differences
"Bone or joint deformity
"Congenital Deformities (birth defects)
"Congenital short femur
"Fibular hemimelia
"Hemiatrophy
"After Trauma
"Growth plates fractures
"Malunion
"Nonunion
"Shortening & deformity
"Bone defects
"After Infection
"Osteomyelitis- bone infection
"After Tumor
"Bone defects
"Short Stature
"Dwarfism
"Constitutional short stature
Advantages of Limb Lengthening
"Surgery on the affected limb
"Correction of accompanying deformities
"Preservation of body length
"Normalisation of body proportions
"Significant gain of length
Disadvantages Limb Lengthening
"Consolidation problems
"Increasing problems with advancing age
"Operation technically difficult
"Possible multiple surgery
"Soft tissue tension
For more information please visit www.orthopedicsindia.com
by: orthocare
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