- Limb Lengthening Fixators
- Distraction Histiogenesis
- Post Op Care in the Ilizarov Method: (by Dr. Mangal Parihar)
- growth deformities of the limbs
- it is important to distinguish between limbs with good potential for lengthening (such as limbs prematurely shortened due to
physeal injury) vs those w/ poor potential for lengthening (such as the congenitally short limb that was never
"programmed" to be long);
- some pediatric orthopaedists will be extremely reluctant to attempt lengthenings of the congentially short limb (such as PFFD)
due to the high complication rate;
- in adults, obtaining more than a 15% increase in limb length is difficult;
- bone density measurements can be helpful in determining whether it is safe to remove the fixator (during regenerative phase);
- Limb Lengthening in Children:
- lengthening of the pediatric diaphysis:
- when projected discrepancy is > 5.1 cm, consider limb lengthening;
- femur can be lengthened in a single stage, upto 3 to 4 cm, or lengthening can be performed gradually over several weeks;
- references: Epiphyseal distraction. Chondrodiatasis.
- transphyseal lengthening
- distraction device is placed across the growth plate & lengthens the limb by causing separation at plate;
- procedure is generally performed just before skeletal maturity;
- congenitally short leg:
- limbs that were never "programmed" to achieve normal length will be at especially high risk for major complications from
- this is in contrast to limbs that are short as a consequence of growth plate trauma, in which case, limb lengthening is a more
reasonable treatment option;
- Complications of limb lengthening in children who have an underlying bone disorder.
- Limb Lengthening of the Femur
- Lengthening of the Tibia
- Specific Lengthening Methods:
- Wagner Method:
- distraction apparatus is applied following a mid-diaphyseal osteotomy;
- following completion of lengthening, the lengthening apparatus is removed, & metal side plate is applied along w/ bone grafting
to diaphyseal defect;
- Ilizarov Technique
- bone is lengthened at a rate of 1.0 to 1.5 mm per day.
- gradual distraction allows the neurovascular bundle and muscles to lengthen safely;
- osteotomy is performed at lower metaphyseal level for enhanced bone healing;
- Lengthening over an IM Nail:
- in report by Simpson AS, et al (1999), authors followed 20 patients who underwent leg lengthening with a combination of ex fix
and IM nailing;
- mean gain in length was 4.7 cm (2 to 8.6);
- mean time of external fixation was 20 days per cm gain in length;
- all distracted segments healed spontaneously without refracture or malalignment;
- there were 3 cases of deep infection, two of which occurred in patients who had had previous open frx of bone which was
being lengthened (all resolved with appropriate treatment)
- authors noted the following advantages:
- early rehabilitation, early return of knee ROM, low rate of complications, shorter period for using external rotation;
- Leg lengthening over an intramedullary nail.
- Immediate Lengthening:
- Limb Lengthening and Correction of Angulation Deformity: Immediate Correction by Using a Unilateral Fixator.
- One-stage lengthening for femoral shortening with associated deformity.
- adults will have a much higher complication rate than children;
- avoid simultaneous femoral and tibial lengthenings;
- occur from stretk
- neurovascular damage from stretching;
- if neurological damage develops, then lengthening must be stopped or reversed;
- consider decompression of the peroneal nerve over the fibular neck along with excision of the fascia lata and lateral
- lengthening should never be attempted through a previous fracture site
Lengthening of congenital lower limb deficiencies.