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External Limb Lengthening for Height Increase

Limb Lengthening Surgery

The limb lengthening procedure works by gradually growing new bone and soft tissues (skin, muscle, nerves, blood vessels, etc). This new growth is called tissue regeneration. In this limb lengthening operation, bone and soft tissue regenerate when they are distracted (pulled apart) at a very slow rate of approximately 1 mm per day. If the rate of distraction is faster than this, bone may fail to form between the two ends of the bone that are being pulled apart and soft tissues, such as muscle, may experience contracture (get too tight) or nerves may become paralyzed. If the rate of distraction is too slow, premature consolidation may occur (the bone may consolidate too soon), preventing the lengthening device from further pulling it apart. There are many different lengthening devices used. The most common are external fixators, which are devices that attach to the bone by means of thin wires or thicker pins that have a screw threading at their attachment to the bone. There are also lengthening devices that are fully implanted inside the bone. These devices do not require external pins. The different devices are described separately.
There are two phases of lengthening until the bone is fully healed: the distraction phase and the consolidation phase.

• The distraction phase: It is the lengthening phase. After the desired length is obtained, the newly regenerated bone is still very weak because of lack of calcium within it.
• Consolidation phase: This occurs when the desired length has been reached and the bone begins to fully grow and harden. The uniqueness and value of distraction osteogenesis lies in its ability to simultaneously expand both the bone volume and the surrounding soft tissue.

Lengthening Devices Used

A variety of orthopedic devices are used to distract the bone and soft tissues. The decision regarding which device to use is individualized for each case, so that the best method to achieve the desired correction can be chosen. There are two general types of devices: external fixators and internal fixators. The external devices attach to the bone from outside the body by means of wires and threaded pins. The internal devices are implanted inside the body and lie on the bone or inside the marrow cavity of the bone. The best known and most versatile techniques are with monolateral (one-sided or straight bar) external fixators (e.g., Orthofix, EBI) and circular external fixators (e.g., Ilizarov, TSF). External fixators are applicable to almost all cases. To shorten the time in the external fixator, doctors often combine the external fixator method with an internal nail to perform the lengthening over nail (LON) technique. This method is not applicable to all cases.
The most popular and widely used device is the Ilizarov apparatus which was designed by Ilizarov. Circular frames are connected by thin wires at multiple panels.

• Advantages: good mechanical stability, traction forces distributed evenly through tissues; good for mechanical line correction; patients can walk on it and do functional exercises.
• Shortcomings: limited lengthening range; long duration of wearing bulky frames; many pin hole scars; difficult to operate, and some complications associated with bone-lengthening are common.

Candidates for leg lengthening

• Congenital Deformities: Children and adults can be appropriate candidates for the procedure. Children with congenital deformities such as fibular hemimelia, congenital short femur and hemiatrophy will often have unequal leg length and this may be associated with deformity. Many adults have had this condition since childhood and have developed back pain and hip arthritis from the leg length discrepancy. Growth plate fractures and bone infections in children can cause stunting of growth those results in discrepancy.
• Deformity Correction: Following trauma, bones can heal in a shortened and deformed position (mal-union). Sometimes the bone can even remain unhealed (non-union). Limb lengthening procedures address all of these issues. We have been able to successfully correct large leg deformities and equalize limbs with discrepancies of several inches. A segment of bone can be missing after a bone tumor, bone infection or severe fracture. We can transport new bone to fill in this defect.
• Height increase: Short stature can be very disabling in patients with dwarfism, for example. We can lengthen both legs simultaneously to increase height. We have been able to lengthen achondroplastic dwarf patients 12 inches in the legs and five inches in the arms. This allows them to function more independently

Pros and Cons of Limb Lengthening

Pros:

• Surgery on the affected limb
• Correction of accompanying deformities
• Preservation of body length
• Normalisation of body proportions
• Significant gain of length

Cons:

• Consolidation problems
• Increasing problems with advancing age
• Operation technically difficult
• Possible multiple surgery
• Soft tissue tension

Authored By: Dr. S. V. Santpure