What is Quadrilateral Lengthening?

Quadrilateral limb lengthening is the surgery of both femur, upper leg, and tibia, lower leg, at the same time. Although it is technically possible, our doctor Yunus Öç does not perform this surgery and does not recommend anyone to have it. There are several reasons why it is not recommended. 

Disadvantages of Quadrilateral Lengthening

1-The Risk for Embolism

An embolism is a blocked artery caused by either a blood clot or an air bubble and it is a life-threatening situation. Because during the quadrilateral surgery all the bones of the legs are broken and cut through, this may cause blood clot which blocks an artery and even cause death. 

2-Prolonged Anesthesia

Because both the bones in the femur and tibia are broken during the quadrilateral limb lengthening surgery, the patient has to stay under anesthesia for longer than they should. Although general anesthesia is mostly safe for patients, the longer the surgery is, the more risks and side effects are present.

3-Multi-Trauma at the Legs

There are 1 bone on the upper leg, femur, and 2 bones on the lower leg, tibia and fibula. Therefore, during the quadrilateral leg lengthening surgery, 6 bones of the patient are broken, which causes multi-trauma. With multi-trauma, too many oedemas, hydropsy, and blood accumulation occur. Most of the patient’s pain threshold is not enough to bear this, therefore too many painkillers are needed after the quadrilateral surgery. 

Too many painkillers may cause addiction and the body creates immunity against the painkillers, which causes them to stop working. In addition, the overdose of painkillers wears out the liver which is a very dangerous situation for health. 

4- Mobility Limitations and Sleeping Problems

The surgery of the femur and the tibia at the same time disturbs the patient’s comfort during the lengthening process immensely. The reason is that the fixator attached to the lower leg is in the anterior and on the sides when it is attached to the upper legs. So, the patient can only lie down on their backs, and can’t turn on their sides. In addition, the patient's mobility gets too limited because their ankles, knees, and hips will hurt simultaneously. They can’t walk properly during the lengthening process and can’t meet their own needs.

Because they can’t walk regularly and their bones are cut in four different places, there is a higher chance of non-bone union. Plus, healthy lengthening limits are 1 mm/a day but because both the lower and upper legs will lengthen at the same time, the daily lengthening amount of the patient will be 2 mm a day, which may cause muscle damage or even muscle strain. 

How Many Times Can You Do Limb Lengthening?

A person can have 2 limb-lengthening surgeries in total for a healthy lengthening process.

You can have your second limb-lengthening surgery minimum of 6 months after your first one. Assoc. Prof. Dr. Yunus Öç highly recommends 6-month-waiting period so that the bone union is completed and the patient will be able to weight bear fully.  

With having one surgery either from the femur or tibia, you can have a maximum of 8 cm height gain. Having two surgeries, on the other hand, you can have a maximum of 12-16 cm height gain. 

Even though quadrilateral lengthening surgery sounds like it will take less time and effort for the lengthening process, the healing process will actually be longer and harder, as opposed to having two separate surgeries.

To get detailed information about limb lengthening surgeries, you can contact our patient consultant.