Pediatric Orthopedic surgeons conducting Limb Lengthening Surgery

LIMB LENGTHENING SURGERY

 

Limb Lengthening Surgery helps children who have not stopped growing.  At Medical City Children’s Orthopedics and Spine Specialists our surgeons are experts at growing a child’s bones.

If your child needs surgery or casting, our Fracture Care Clinic opens every day and you do not need an appointment. Surgery rooms get scheduled every morning, so your child receives the care and attention they need right away.

Limb Lengthening Surgery

Limb lengthening is a surgical procedure that balances the patient’s gait, corrects height proportion, and resolves cosmetic issues. In order to lengthen limbs, it is a meticulous, time-consuming technique. Through tiny incisions in the damaged leg, the reconstructive surgeon conducts a surgical ostomy (breaks) on the femur and/or tibia. Legs or arms that are shorter than the other might have limb length disparities for a variety of causes. One limb may develop more slowly than the other in a newborn due to a disorder.

Complicated fractures or broken bones that heal poorly can stop the arm or leg from growing. Alternatively, surgery to remove the bone cyst may prevent the limb from growing. In both cases, orthopedic specialists like those in our practice may recommend leg lengthening surgery as an option. Before deciding to have limb lengthening surgery, patients or their families should understand what the surgery entails and the risks associated with it. What a limb extension incorporates, how it works, and what patients need to know before making a final decision.

Who Needs Limb Augmentation?

If your child has experienced an accident or injury that has caused a limb to not grow like the other, surgery might easily correct the problem. The following diseases may stop the growth of a limb and doctors could recommend Limb Lengthening Surgery:

  • Hemihypertrophy is a condition where the sides of the body develop at different speeds.
  • The uncommon disorder neurofibromatosis can lead to skin issues, the curvature of the spine, and overgrowth in one limb.
  • Growth following a fracture.

Why Limb Lengthening Surgery Is Performed

If a child has a significant discrepancy between their legs, leg lengthening may provide the solution (more than 5 cm or 2 inches). To proceed with Lim Lengthening Surgery, the following aid in decision making:

  • Kids whose bones are still developing.
  • For those who are petite.
  • For kids whose growth plates contain anomalies.
  • For those whose injuries caused a shortened or lengthened limb.

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. It is advised 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. For the best outcomes, the timing of this therapy is crucial. Leg length inequality may result from certain medical disorders. Among them are

  • 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 that are present 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. The procedure involves cutting the bone surgically, then fastening a tool that gradually pulls the two ends of the bone apart. New bone fills in the void as it develops between these two ends. Depending on their age, stage of growth, and the amount of lengthening required, patients frequently go through many rounds of lengthening over the course of several years. Leg length inequality is most frequently fixed via limb lengthening. To prevent back, hip, and knee issues that might arise from moving about on legs that are various lengths, leg lengthening aims to level the body. Most arm-length disparities don’t have an effect of this nature. Only when a shorter arm causes problems with daily tasks is lengthening taken into consideration.

How does Limb Lengthening Surgery Work?

Magnetic extension rods and pins are inserted into your child’s bones, which allow the parents to make adjustments that will extend the growth of bones in the legs in a controlled manner for a period of 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 are placed on the bones.

What is the Best Way to Make Bones Grow?

There are a few other tools that can make 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.

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 be taken very seriously 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 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, who 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 center meter (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 remained 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 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 is being stretched 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 danger 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.

It is inevitable that difficulties may arise during limb lengthening. What those issues will be and how soon we can spot and correct them are the key questions. We may reduce the danger and consequences with thorough preparation before surgery and a very cautious approach during the operation. If a parent decides to have his or her child undergo this operation, the doctors and staff will inform them of the pros and cons to include reasonable expectations of the results. It involves the whole team.

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, which might cause long-term nerve and tissue damage. On the other hand, the bones may link together too rapidly — causing future problems — if the distance is extended too slowly. Older children should not smoke and anti-inflammatory medication avoided.

Call 214-556-0590 to make an appointment.

Comprehensive services for children from birth through adolescence at four convenient locations: Arlington, Dallas, Frisco and McKinney.