Types Of Limb Lengthening Surgery

Nowdays most of the  people with short stature, or who were born with  limb length discrepancy , or  leg deformities  try to solve this problem with a surgery.  In this article you can get some important information about this procedure, including different leg lengthening techniques , recovery time, and making sure you’ve chosen the right, experienced surgeon.

Bone lengthening procedure was invented in the 1950s. In the early 1980s, limb lengthening procedures were adventurous with new devices and techniques. But one thing remains a constant with a new advancement: limb lengthening requires a combination of technology and the body’s ability to regrow new bone – under the careful guidance of an orthopedic surgeon and special devices – in order for patients to achieve longer legs.

There are two common types of leg lengthening procedures, both of which require a cutting and a bone stabilizing device, which is either implanted inside the bone (internal limb lengthening) or attached outside the leg (external limb lengthening) to the lengthen the legs and correct deformities.

External Leg Lengthening

In 1982, Gavril Ilizarov who was a Soviet physician, known for inventing the  Ilizarov apparatus  for lengthening limb bones and the method of surgery named after him, the  Ilizarov surgery . The Ilizarov technique was a major breakthrough in leg lengthening, as it was allowed for the orthopedic surgeon to hold the bone in place. The practice of using an external device, such as the Ilizarov apparatus, is referred to as “external method of leg lengthening.”

The innovative surgery begins with an osteotomy, the procedure of surgically cutting a piece of bone, and then requires a procedure to help stabilize the limb with a fixation device, which is often the Ilizarov apparatus.

The surgery is typically performed under general anesthesia. After surgery, the patient will be required to adjust the device. Coupled with physical therapy, this procedure can increase the length of the bone by 5-8 cm in one procedure. In many cases, this equates to approximately 2 to 3 inches of extra bone growth.

When only an external fixator is used, the fixator needs to remain in place for both the distraction and  consolidation phases . If the fixator were removed before the bones have healed, patients would face the risk of breaking the bone again and experience significant damage.

If you would like more information about external fixators please visit:  Limb lengthening Using External Fixation 

Lengthening over nail (LON) method

Lengthening over nails (LON)  is a newer leg lengthening method. A combination of intramedullary nailing along with external fixation significantly reduces external fixation time while maintaining low rate of complications. Great care needs to be taken to prevent pin track infection and deep intramedullary sepsis. This method of limb lengthening surgery requires a small nail, which is then attached to an external fixator. Following surgery, the patient slowly turn the screws to gradually stretch the bones over the nail. It is possible to use ilizarov and any monorail fixator for external limb lengthening procedures in LON method .

Lengthening and then nail (LATN)

ilizarov method types of limb lengthening surgeryIlizarov technique

In case of LATN (Lengthening and then nail), during 1 st  stage surgery, only an external fixator is installed, and after full lengthening, during 2 n d  stage surgery, the external fixator is removed and an intramedullary nail is inserted. During 1 st  stage surgery, future space needed for the internal rod. Also, the correction process before 2 nd  stage surgery requires much knowledge and care from the doctor.

A large advantage of LATN is that bone formation is fast and because of strong internal fixation, compared to LON, patients can return to normal activity 2 or more months faster. Also, since it undergoes a correction process, precice bone alignment can be met.

One drawback is that the amount of time wearing the external fixator may be 2 or 3 weeks longer than LON, because of the correction process.

Internal Leg Lengthening

Intramedullary nailing  is a procedure of fixation of fractures that involves use of an  intramedullary nail  or rod to fix the fractured bone. Limb lengthening patients , who do not want to carry. There are now cutting-edge technologies that lengthen the bone from the inside, like the Precice and the Fitbone.

Precice  is an internal limb lengthening device that requires the surgical implantation of a titanium rod into the bone cavity. The device is removed after one or two years time through a relatively minor outpatient procedure. It can lengthen the bone by up to 3 inches.

Precice Stryde is an improved version of Precice nail. Its main advantage over the earlier Precice 2.2 version is weight bearing capability. With Stryde method, patients can walk during bone lengthening period, while in Precice 2.2 method they would need to use wheelchair and wouldn’t be allowed to walk (it can damage the motorized nail mechanism, requiring the nail to be replaced)

cosmetic limb lengthening types of limb lengthening surgeryIntramedullary nailing

Recovery after Limb Lengthening Surgery

Recovery times can vary depending on which type of surgery you choose. Regardless of whether an internal or external lengthening device is used, there will be a lengthy period of recovery, called the “consolidation phase.”

The total time in the external fixator can be estimated to be approximately 1 month for each centimeter of children and 1.5 to 2 months (or longer) per centimeter for adults. Total fixator time is divided evenly between the distraction and consolidation phases.

Bone healing is evaluated with X-rays. The X-ray shows the amount of calcium present in the bone. After the bone is healed, the internal nails, or external fixators (depending on a surgical method) are removed. Throughout this period, regular physical therapy and follow-up visits will be required.

Candidates for Limb Lengthening and Deformity Correction Surgery

The most common candidates for limb lengthening are people with birth defects, knock-on knees, foot and / or bowleg deformities, limb length discrepancy, and most other leg deformities. This procedure is also common among people with fractures or broken bones that did not heal properly (malunion or nonunion) and those with dwarfism.

Besides the cosmetic benefits, some patients undergo leg lengthening surgery when they’ve experienced long-term issues associated with their defect, including arthritis. In these instances, as well as cases of deformities, the procedure is likely to be covered by insurance.

In pediatric orthopedist. Both bowing of the legs, in which the knees are abnormally separated, and knock knees, in which the knees are abnormally close together, in a family member during early childhood. In many cases the alignment of the legs corrects naturally. But if it is impossible to correct the legs naturally, it is required to do surgery.

With pediatric leg lengthening, a doctor will first observe the growth plate (the area of ​​the bone that indicates how much the bone will grow). Children with differences in limb lengths and a myriad of other deformities are often good candidates for limb lengthening procedures.

According to the Hospital for Special Surgery, children who have limb lengthening procedures heal in roughly half the time it takes adults to recover. Pediatric patients typically have the same options as adults. They also typically see better results, with the ability to lengthen the bone by up to 8 inches.

Although previously reserved for those with congenital anomalies and developmental disorders, limb lengthening surgery has become popular for cosmetic purposes as well. The procedure is largely the same for those who undergo it.

If you would like to get information about the post-op period you can see: Limb Lengthening Surgery Post-op Period, Problems and Complications 

Single Leg Lengthening (Leg Length Discrepancy) Before After wannabetaller.com:

Cost of Limb Discrepancy Surgery:

Singular Limb (either Femur Or Tibia) Lengthening surgery for limb discrepancy correction, with:

For all other types of limb correctional surgeries and treatments please contact our patient’s consultants for more information and pricing.

Moreover, for a thorough, healthy and smooth treatment experience, we provide the following facilities, which are included in the total price that we charge for the surgeries:

  • Meeting and greeting our patients at the airports, including all transportation, to and from their hotels & hospitals
  • Accommodation in a 5-star hotel (1 to 3 days)
  • An English-speaking caretaker who will assist our patients 24/7
  • A Complimentary Istanbul tour, including historical and touristic visits, boat tours and meals in our famous Turkish restaurants
  • All necessary medical examinations before the surgical operation
  • 5 to 7 days of hospitalization
  • Physiotherapist’s assistance and all medications are covered, during the patient’s hospitalization
  • Walkers, crutches & wheelchairs
  • Transportation to the airport upon departure
  • FREE consultation with doctors and consultants, whenever the patient’s needs, even after the lengthening process has been completed.
  • Device removal surgeries cost 750 eur and are NOT included in total surgery cost (in LON method, external fixator removal costs 750 eur and internal nail removal is 750 eur)

Please note that this stated price also includes the following costs, besides, to the surgery itself:

  • All hospital charges relating to the operating room and recovery room.
  • Surgeon fees.
  • Anesthesiologist fees.
  • Surgery assistant fees.
  • Hospital fees (Internal medicine doctors will be available during the entire hospitalization period).

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