LIMB LENGTHENING SURGERY

QUESTIONS AND ANSWERS

Causes

For slight variations in leg length, leg shortening or restriction is a possibility (usually less than 5 cm or 2 inches). In youngsters whose bones have reached their adult size, our doctors may recommend shortening a longer leg. Doctors recommend the procedure for kids whose bones are still forming to control their bone development. This procedure prevents a longer bone from growing while allowing the shorter bone to continue to lengthen to match it.  Leg length inequality may result from certain medical disorders. The following identifies them:

• Cerebral palsy.
• Small, feeble muscles or short, contracted (spastic) muscles may inhibit the development of normal legs.
• Legg-Perthes disease and other hip conditions.
• Damaged bones or prior injuries.
• Deformities identified at birth affect the bones, joints, muscles, tendons, or ligaments.

The Purpose of Limb Lengthening Surgery

Limb lengthening causes the patient’s arm or leg bone to elongate. This procedure involves reducing the length of the longer limb. Doctors consider this procedure for patients with limb length differences of about 2 to 5 cm. This procedure helps people who have completely stopped growing or are near the end of growing. If the child does not qualify for epiphysiodesis and you do not want your child to undergo a limb lengthening or height growth operation, this procedure may provide positive results. The surgery removes a length of bone from the longer limb and uses a rod or metal plate to hold the bone together. This will make both legs equal.

What to Expect During Limb Shortening Surgery

The surgery itself is carefully planned. The surgeon makes a precise cut in the bone of the longer limb, making sure to preserve blood flow and the body’s natural healing processes. After removing the necessary segment of bone, the ends are brought together and stabilized with a rod, plate, or screws—much like putting together the pieces of a puzzle and holding them firmly in place.

Your child will typically stay in the hospital for at least one night following the procedure. This allows for close monitoring as the initial healing begins. After a short period of rest—usually a week to 10 days—your child will start gentle movement, and doctors may recommendphysical therapy to help restore strength and mobility.

As with any bone surgery, follow-up appointments and X-rays should occur to ensure the bone is healing correctly and the limbs remain equal in length. It’s important to note that while this surgery can provide excellent results for certain patients, it may not work for all cases. Our doctors will take the time to explain all the options, so you can make the best decision for your child’s long-term health and comfort.

How Does Leg Lengthening Differ from Arm Lengthening?

Though doctors can lengthen both arms and legs using similar surgical techniques, there are a few key distinctions in how we approach each case.

First, the impact of length differences appears more significant in the legs. Even a small imbalance between leg lengths can affect your child’s ability to walk, run, or maintain proper posture. With arms, differences typically become a concern when they affect day-to-day activities, like buttoning a shirt, riding a bike, or comfortably resting the arm on a desk.

Additionally, the types of medical devices used may vary. For leg lengthening, we often use internal rods (fixators) when the bone is wide and strong enough—this offers stability for weight-bearing bones. However, in the arms, especially for growing children whose bones continue to develop, external devices are sometimes the safer and more effective choice.

Our team carefully evaluates each child to determine the safest and most effective method for their unique needs, ensuring both arms and legs are given the expert care they deserve.

Why Are Different Devices Used for Leg and Arm Lengthening?

Although the overall process of limb lengthening is similar for both arms and legs, the devices used can differ based on the unique anatomy and function of each limb.

Leg bones are typically larger and provide more space to safely insert internal rods, such as the Precice system or Stryde nail. Internal fixators are often preferred for leg lengthening because they are less bulky and allow for easier movement during recovery. In contrast, arm bones in children are usually narrower, making it more challenging to use internal rods without risking damage to the bone or surrounding tissues. As a result, external fixators—like ring or monolateral frames—are more commonly selected for arm lengthening, especially in younger children whose bones are still developing.

Additionally, the impact of limb length discrepancies is different depending on whether it’s an arm or a leg. Differences in leg length can cause issues with walking, running, and posture, so correcting even small discrepancies is important. For arms, the main concern is how the difference affects day-to-day function, such as self-care or recreational activities.

By selecting the appropriate device for each situation, surgeons can ensure the safest and most effective outcome for your child.

How Does Limb Lengthening Surgery Work?

Magnetic extension rods and pins are inserted into your child’s bones, which allows the parents to make adjustments that will extend the growth of bones in the legs in a controlled manner for some time. There are external magnets mounted on pegs that mechanize the gears of the fixture and move the telescopic rods. A magnet rotates a gear in the rod to extend the length of the limb. By utilizing this advanced technology, limb surgeons can limit and/or eliminate the use of previously used external fixation. After placing the magnetic rod and pins, patients are instructed on how to adjust the rod to lengthen the bone over time, usually between ½ and 1 millimeter per day for the next three months.

As the bones gradually lengthen, the muscles, tendons, skin, and arteries also respond and grow. The actual stretch phase is called “distraction,” when the bones slowly stretch over time. Then there is the “consolidation” phase in which the bones begin to heal and calcify, and finally, the recovery phase, when rehabilitation begins and greater weight control is placed on the bones.

How is the daily rate of limb lengthening determined?

The rate at which a child’s limb is lengthened is carefully tailored to each individual, with safety and optimal bone growth in mind. Most often, orthopedic surgeons follow a standard rate of about one millimeter per day, roughly the width of a pencil tip. This gradual pace encourages healthy new bone to form while minimizing stress on surrounding muscles, nerves, and joints.

However, the surgeon monitors the child’s progress closely. If the bone heals slower or faster than expected, or if your child experiences stiffness, nerve discomfort, or changes in the soft tissues, the doctor can adjust the rate accordingly. Sometimes, lengthening is slowed or briefly paused to let tissues recover and to prevent complications. The overall goal is to ensure balanced limb growth while prioritizing your child’s comfort and long-term function.

Is limb lengthening surgery painful?

It’s natural to wonder about pain when considering limb lengthening surgery for your child. While some discomfort and soreness are common after the procedure, especially during the initial weeks, our team stays vigilant in managing your child’s pain and ensuring maximum comfort throughout recovery.

Typically, the surgical site may feel tender at first, and your child might experience tightness in the muscles or a sensation of stretching as the limb gradually grows. This is a normal response as the bone, muscles, and soft tissues adjust to the lengthening process. However, most children do not experience sharp or severe pain during the ongoing lengthening; rather, it’s more often described as an ache or tightness.

To help minimize discomfort and support healthy healing, physical therapy or occupational therapy plays an important role. These therapies are customized to your child’s needs and focus on maintaining flexibility, mobility, and strength in the affected limb, making the overall process smoother and more tolerable.

What is the Best Way to Make Bones Grow?

There are a few other tools that can fill a gap in the bone. The first is a frame that the patient wears for several months on the outside of their leg or arm. After the initial operation, the patient or a family member will extend the frame (and the bone) very slightly at regular intervals to encourage bone development. An inflatable rod is a new alternative that many patients favor. The rod is put into the bone once it has been cut. A magnetic controller located outside the limb lengthens the rod. The inside device lessens the danger of infection and harm to the surrounding skin and muscles compared to the frames.

How much can a bone be lengthened in one procedure?

The potential lengthening that doctors can accomplished in a single procedure depends on several important factors, including your child’s age, the type and size of the bone, and the overall health of the limb. Generally speaking:

• For most children, doctors can safely lengthen the bone by up to 2 inches (about 5 centimeters) during one treatment cycle.
• When the limb length difference exceeds this amount, additional procedures—spaced over months or even years—will occur for gradual, safe correction.
• Bones in the arms and legs respond differently to treatment. As a guideline, legs are often lengthened up to about a quarter (25%) of their original length, while arms may tolerate a lengthening up to 40% of their original bone size per cycle.

Ultimately, each case is unique. The surgical team will carefully assess your child’s situation to recommend a lengthening plan that balances desired outcomes with safety and long-term mobility.

How strong is the new bone after limb lengthening?

• Bone Strength: Once the newly formed bone matures completely, it becomes just as sturdy and resilient as any other bone in your child’s body.
• Return to Activity: After proper healing, most children can return to their usual activities, sports, and play without any added risk of fracture or weakness in the lengthened bone.
• Long-Term Durability: With ongoing follow-up and care, the new bone maintains its strength for years to come, allowing your child to move, run, and explore as they did before, just with legs or arms now at a matching length.

After Limb Lengthening Surgery

• The person will spend several days in the hospital. Frequent visits to the doctor are necessary to adjust the extender device. The duration of use of the extension device depends on the extension required. Physical therapy is required to maintain a normal range of motion.
• The pins or screws that hold the device should stay clean to prevent infection.
• The time it takes for the bone to heal depends on the length of the extension. It takes about 36 days for every inch of growth.

It’s crucial to constantly evaluate the foot and toes’ skin color, warmth, and feeling because the blood vessels, muscles, and skin are all involved. This will make it easier to identify any blood vessel, muscle, or nerve injury as soon as possible.

How is pain managed during and after limb lengthening surgery?

• Pain Management: Managing discomfort is a top priority during the recovery period. After surgery, children may experience some pain or soreness, particularly in the initial weeks. Our clinical team employs a combination of pain-relief strategies tailored to each child’s needs, which may include oral medications, localized treatments, or, in certain cases, nerve blocks recommended by the anesthesiology team.
• Ongoing Support: As the lengthening process progresses, children may notice their muscles feeling tight or achy. Regular adjustments to the device are generally not described as painful, but can cause temporary discomfort. Our multidisciplinary team, including specialized pediatric physical and occupational therapists, works closely with your child to minimize pain, gently stretch tissues, and support mobility.
• At-Home Care: Parents also play an important role in monitoring comfort levels at home. We provide clear guidance on how to manage mild soreness, such as applying ice packs, using prescribed stretches, or following medication instructions. This collaborative approach helps ensure your child remains as comfortable as possible throughout their healing journey.

How Long Does it Take to Recover?

After the surgery, the child will typically stay in the hospital for a few days. Parents and their child will visit a physiotherapist the day following surgery.  The therapist will create a daily workout regimen that is an essential component of the process. A few days following surgery, new bone will often start to develop. We refer to this as the latency period. Our doctors and staff will instruct the parents on how to use the fixator to extend the bone every day.

The fixator will continue to stay in place while the bones solidify.  Once the bone has achieved the necessary length, the parent can stop making adjustments to the fixator. The fixator provides an extra 1 centimeter (CM) of bone for every 60 days that the device is in place. Therefore, if your child’s legs have grown 4 CM longer, the fixator remains in place for eight months. Before the fixator gets removed, the patient will get routine X-rays to ensure that the new bone is healing properly.

What Happens to the Muscles, Nerves, and Skin Around the Bone as it Lengthens?

The soft tissues slowly stretch around a bone as it grows longer. Comparing it to everyday stretching, your child can gradually touch their toes without pulling on the hamstrings. Throughout this procedure, the surgeons keep a watchful eye on the patients. Surgeons will slow down, or sometimes even stop, the lengthening process if a nerve or muscle stretches too far.

Benefits of Limb Lengthening Surgery

The advantages listed below are cited by patients who have limb lengthening surgery:

• Height proportion.
• Balanced gait and walk.
• Psychological impact.
• Physical impact.

Are There Risks Connected to Limb Lengthening Surgery?

There are some very real dangers. Patients who have their limbs lengthened run the risk of developing arthritis, joint contracture, muscle damage, and dislocations. While they are evaluating their alternatives, we make sure that our patients are aware of this. We can avoid, or at least significantly reduce, the difficulties that are inherent in lengthening operations by keeping an eye on the lengthening process and modifying it as necessary.

Difficulties may inevitably arise during limb lengthening. If and when they occur, we will correct them. We may reduce the danger and consequences with thorough preparation before surgery and a very cautious approach during the operation. If parents decides to undergo this operation for their child, the doctors will inform them of the pros and cons.  The information will also include reasonable expectations of the results. 

What Effects Does Limb Lengthening Surgery Have Over the Long Term?

As long as the proper steps are taken throughout the consolidation phase, limb-lengthening surgery yields positive outcomes. However, the new bone may not develop properly if the distance between the bones is extended too quickly.  By being to fast, it may cause long-term nerve and tissue damage. On the other hand, the bones may link together too slowly and cause future problems as well. Older children should not smoke, and anti-inflammatory medication avoided.

Make an Appointment with Medical City Children’s Orthopedics and Spine Specialists

We specialize in children and medical conditions affecting their limbs.  Finally, we have offices in Dallas, Arlington, Flower Mound, Frisco, and McKinney, Texas. By the way, our doctors, Shyam Kishan, Richard Hostin, and Kathryn Wiesman, have spent years studying children’s health and have devoted their lives to treating them. We welcome new patients and invite you to call us for an appointment for your child. Call today for an appointment.

Our team’s expertise extends beyond just the surgeons.  You will also find dedicated physician assistants, nurse practitioners, and physical and occupational therapists who specialize in limb-length differences. We understand that childhood growth patterns can significantly influence the limb lengthening process.  Our specialists are committed to tailoring every treatment to maximize limb function now and as your child grows.

Conclusion

Limb lengthening and reconstruction procedures appear complex and come with important considerations.  Our approach is always thoughtful and patient-centered. We know that every child is unique, so ensure parents fully understand their treatment options. From early childhood through early adulthood, we’re here to guide, support, and care for your child every step of the way.

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Footnote:

WebMD: Leg Lengthening