Limb Lengthening Surgery - How Bones Are Surgically Extended

Introduction

Limb lengthening surgery is a medical procedure that aims to correct differences in the length of bones in the arms or legs by increasing their overall size. It is a time-consuming, months-long process that requires patients' full devotion. This progressive procedure lengthens the arm or leg bones while extending soft tissues such as muscles and nerves. It requires extensive physical therapy during recovery. In general, limb lengthening is a complex medical procedure that, when performed properly by a skilled surgeon, has the potential to restore more normal limb lengths and functionality.

What Is Limb Lengthening Surgery?

Limb lengthening is a surgical procedure to lengthen bones in the arms or legs. It is done to:

• Correct limb length discrepancies.

• Treat conditions causing stunted bone growth like dwarfism.

• Improve function in shortened limbs.

In limb lengthening surgery, bones are cut into two segments, and a lengthening device is attached. Over time, the device slowly pulls the two bone segments apart, allowing new bone to regenerate in the gap. As the bone is lengthened, surrounding muscles, tendons, ligaments, and skin also stretch to accommodate the new length. The process takes many months and allows the limb to be extended by approximately one to three inches. In a single surgery, the length of the leg and arm bones can often be increased by 25 % and 40 %, respectively. Those with more large disparities may require repeated procedures over several years.

What Happens During the Process of Limb Lengthening Surgery?

Limb lengthening surgery comprises three main stages: the initial surgical procedure, the distraction phase, and the consolidation phase.

Surgery Phase:

In the initial surgery, the bone that will be lengthened is cut in a specialized way that preserves blood flow. This osteotomy allows the bone to be divided into two segments. The surgeon then attaches a lengthening device, which can be either external or internal:

• External fixators have a frame placed outside the limb attached to the bone by pins.

• Internal devices, such as precice nails, are inserted which are rods within the bone's marrow cavity.

• After surgery, the patient is admitted to the hospital for one to three days to recover.

Distraction Phase

The distraction period lasts around one to two months. This is when the two bone segments are gradually apart to create a gap between them. With external fixators, patients or family members turn a dial on the device daily to lengthen it by one millimeter per day. For internal rods, patients use a handheld remote controller to lengthen the implant. As the gap widens between the bone segments, new bone tissue starts forming in the space. Simultaneously, surrounding muscles, nerves, ligaments, and skin stretch with the lengthening. Patients attend physical therapy frequently during this phase - up to five times per week. The surgeon studies X-rays every one to two weeks to confirm that the lengthening rate is optimal for new bone formation.

Consolidation Phase

Once the final length is achieved, the lengthening stops. The new "regenerated" bone then consolidates and strengthens over two to three months. Physical therapy continues to maintain flexibility while the patient progressively begins weight-bearing.

By the end of the consolidation period, the new bone has completely healed, and the device can be removed. Following removal, patients may be required to wear a brace or cast for a while. The complete process takes at least four to five months, but more likely six to nine months, depending on parameters such as the amount of lengthening.

What Is Involved in Limb Lengthening Recovery?

The lengthy recovery and rehabilitation is a major component of limb lengthening. Age, overall health, and use of tobacco or alcohol can all have an impact on the rate and effectiveness of bone repair. Here are important recovery considerations:

• Physical therapy for two to five times a week is required to maintain flexibility and strength. Patients must also complete their assigned home exercises.

• Periodic X-rays enable the surgeon to evaluate new bone growth and make changes as needed.

• Individuals should avoid smoking or using nicotine, eat a protein-rich diet, and consider taking supplements to promote and support bone formation.

• Weight-bearing of the leg is initially restricted following surgery and then gradually increased under physician supervision.

• When the device is removed, the patient may need to wear a cast or brace for a brief time.

• Pain medications and nerve blocks help manage discomfort, especially in the early postoperative period.

• Full recovery takes at least six months, and patients should avoid intense activity during that time.

• With proper rehabilitation, the lengthened limb can restore normal strength, range of motion, and function, enabling a return to sports and an active lifestyle. Those undergoing arm lengthening regain use for daily tasks as well. However, the process requires commitment from both the patient and the provider.

What Are the Possible Complications?

Despite the finest surgical care, limb lengthening poses a risk of complications. The most common complications are

1. Pin Site Infection: Pin site infections are more common with external fixators because bacteria can enter the device through the pins that secure it. To treat these infections, antibiotics are often used to eradicate the infection before proceeding with the surgery.

2. Premature Bone Consolidation: It occurs when the nascent bone hardens before it reaches the proper length. This may demand an additional osteotomy procedure to re-cut the bone, allowing lengthening to continue.

3. Delayed Bone Healing: It indicates that the bone is growing slowly and producing insufficient new tissue. The surgeon may need to lessen the distraction rate to improve bone development. Factors such as smoking prevent bone development.

4. Nerve Injury: It is possible if nerves get overstretched during the lengthening process. This can often be resolved with surgical decompression to release pressure on the nerve.

5. Muscle Contractures: This results when muscles fail to stretch enough and become overly tight. Aggressive physical therapy and stretching help maintain flexibility and prevent contractures.

6. Dislocated Joint: It can arise when adjacent joints, such as the knee or elbow, become misaligned as the limb lengthens. Preventing extremely rapid lengthening lowers this risk.

7. Fractures: Fractures are also a problem once the device is removed since the rebuilt bone may still be fragile. Braces used immediately after removal help to prevent fractures during recovery.

While challenging, close monitoring by an experienced limb-lengthening surgeon allows early detection and management of most complications.

What Are the Benefits of Limb Lengthening?

When successful, limb lengthening surgery provides tremendous benefits, including:

• Restores more equal limb lengths, resolving length disparities.

• Enhances posture, walking abilities, and natural gait.

• Increases range of motion, flexibility, and strength in the lengthened limb.

• Reduces pain caused by limb length differences.

• Enables greater performance of daily tasks and activities.

• Provides significant functional and cosmetic improvements.

• Boosts self-confidence.

Limb lengthening can be life-changing for people who have differences due to birth deformities, growth anomalies, previous injuries, or surgery. However, reasonable expectations are necessary because even effective operations have limitations.

Conclusion

Limb lengthening can greatly improve function and quality of life for those with limb length discrepancies. However, the intensive surgery and lengthy recovery require full commitment. Understanding the entire process prepares patients to undertake this transformative procedure under the care of a skilled surgeon.