Sometimes, due to birth or an accident at some point in life, there may be a slight difference in the length of our arms or legs. For some, this can affect their daily activities as well as their mental health. So if you are also someone who is troubled by this kind of problem, today we will talk about the solution to it. That is limb lengthening surgery.
Simply put, what is Limb Lengthening Surgery?
As the name suggests, this is a surgical procedure that lengthens a bone in our arm or leg. It is done very carefully and slowly. Surgeons can lengthen the following bones with this procedure:
- Humerus: That's the bone in your upper arm.
- Radius/Ulna: The two bones between your wrist and elbow.
- Femur: The bone in the thigh. This is the longest bone in our body.
- Tibia: The shin bone between the knee and ankle.
In what cases is this surgery recommended?
This surgery is usually performed on people who have a significant discrepancy in the length of their arms or legs. Doctors also recommend it as a solution for some medical conditions that affect bone growth. For example, if one leg is shorter than the other and you experience back, hip, or knee pain when walking, this surgery can provide a solution.
These are some of the common situations in which this surgery may be necessary:
- A non-cancerous tumor in a bone growth plate .
- Conditions such as cerebral palsy .
- Congenital conditions such as one thigh bone (femur) being shorter than the other at birth (Congenital femoral deficiency) .
- Hemihypertrophy is a rare condition in which one side of the body grows faster than the other.
- Genetic conditions such as Skeletal Dysplasia . These cause abnormal bone growth. For example, dwarfism can be called dwarfism.
- Growth plate fractures.
- Bone infections such as osteomyelitis .
What do you need to know before surgery?
Before you have this surgery, your doctor will take several X-rays of your bones and take precise measurements. These measurements will determine how long the bone needs to be lengthened. Typically, a bone can be lengthened by up to 2 inches (about 5 centimeters) in one surgery.
Your medical team will give you the necessary instructions before surgery. In particular, ask them clearly about what medications you should and should not take before surgery, and when you should stop eating and drinking .
The most important thing is to have someone to help you after surgery. You may need help getting dressed, preparing meals, and going to the bathroom for a few weeks. So talk to someone at home about this in advance and be prepared.
This surgery is usually performed under general anesthesia. So you won't feel any pain. You will have to stay in the hospital for about three days after the surgery.
How is the surgery performed?
There are two main steps in this surgery.
1. Osteotomy: First, the surgeon carefully cuts the bone into two parts.
2. Installing a device: Then, a special device (Limb Lengthening Device) is installed on these two cut bone pieces.
There are two main types of these mounting devices. Let's look at the difference between the two as follows.
| Type of device | A description about it |
|---|---|
| External Fixator | In this procedure, the surgeon attaches a thin metal frame to the two bones using pins or wires. Most of the frame and equipment are outside the body. This can make it difficult to wear certain clothes. Many people wear things like shorts. The areas where the pins are attached need to be kept clean at all times. |
| Internal Rod | This is the latest technology. What happens here is that a screw-like device is inserted into the bone. So it's not visible from the outside. You have to control it with a device like a remote control. This is a much easier method and has a lower risk of infection. |
How does the bone lengthen after surgery?
As you begin to heal after surgery, the most important phase begins. That is the distraction phase . This is a period of about two months. During this time, the two pieces of bone that were cut start to move very far apart.
There are three main ways this process occurs:
1. Adjusting the Device: You will need to adjust the device several times a day, by very small amounts. Each time you do this, the two bones move a little further apart. As this gap forms, the body grows new bone to fill it. With an external device, you have to turn a small knob. With an internal device, this is done with a remote control.
2. Physical Therapy: This is a must-do . Physical therapy is essential for best results. You will need to attend several sessions per week. This will strengthen your muscles, increase joint mobility, and help strengthen the new bone that is forming.
3. Regular Check-ups: Your doctor will take regular X-rays to check how the new bone is growing. If the growth rate is too slow or too fast, the treatment plan can be adjusted accordingly.
The period when the bone becomes stronger (Consolidation Phase)
Once the bone has reached the desired length, it needs time to strengthen, or "soften." We call this the consolidation phase. This can take about three months. During this time, you will stop adjusting the appliance. But you will need to continue physical therapy. Gradually, with your doctor's advice, you can begin to put weight on that arm or leg.
Remember, don't walk on your own until your doctor tells you to. Doing so could damage the new bone.
What are the benefits and risks of this surgery?
Like any surgery, this one has benefits as well as some risks.
Advantages
- Correcting the length of the limbs results in correct gait and posture .
- Increased flexibility and range of motion in joints.
- Increased muscle strength .
- Elimination of back, hip, and knee pain caused by limb length differences.
Risks/Complications
- The newly formed bone is not properly consolidated .
- The bone does not reach the expected length.
- Damage to surrounding muscles or nerves .
- Infections of the surgical wound or bone.
- Infections at the pin insertion sites in people using an external device.
- Stiffness of the joints or muscles of the outstretched arm or leg.
When to see your doctor immediately
If you experience the following symptoms, call your doctor immediately or go to the nearest hospital Emergency Department (ETU) .
- Fever .
- Blood, pus, or other fluid leaking from the device's pin insertion points.
- Redness and swelling of the surgical wound or the areas where the pins were inserted.
- Severe pain or swelling in the outstretched arm or leg.
- Numbness or loss of sensation in an outstretched arm or leg.
- Nausea and vomiting .
- Chest pain or difficulty breathing (this is a very serious emergency).
For this surgery to be successful, it is essential that you follow your doctor's instructions carefully, attend physical therapy sessions, and eat a nutritious diet. While this may take some time and patience, the end result can make a big difference in your life.
Take-Home Message
- Limb Lengthening Surgery is a successful procedure used to correct a difference in the length of an arm or leg.
- This is a slow process that takes several months, so patience is very important.
- Physical therapy is essential for the success of the treatment. Don't skip it.
- Follow your doctor's instructions exactly, especially regarding weight-bearing and exercise.
- This process is now easier and safer than before, thanks to new internal rods.
- If you have any doubts or unusual symptoms, consult your doctor immediately.
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