Type of Surgery
Information
Last updated: 11/24/2009
Leg lengthening
Leg lengthening is performed under general anesthesia, so that the patient is deep asleep and can't feel pain. Of the several surgical techniques developed, the Ilizarov method, or variation thereof, is the one most often...
used. An osteotomy is performed, meaning that the bone to be lengthened is cut, usually the lower leg bone (tibia) or upper leg bone (femur). Metal pins or screws are inserted through the skin and into the bone. Pins are placed above and below the cut in the bone and the skin incision is stitched closed. An external fixator is attached to the pins in the bone, which is used after surgery to gradually pull the cut bone apart, creating a gap between the ends of the cut bone in which new bone growth can occur. The fixator functions much like a bone scaffold and will be used very gradually, so that the bone lengthens in extremely small steps. The original Ilizarov external fixator consists of stainless steel rings connected by threaded rods. Each ring is attached to the underlying bone segment by two or more wires, placed under tension to increase stability, yet maintain axial motion. Titanium pins are also used for
supporting the bone segments. Several fixators are available and the choice depends on the desired goal and on specific patient requirements.
Other surgical techniques, such as the Wagner method, or acute lengthening, are used much less commonly. The Wagner technique features more rapid lengthening followed by bone grafting and plating. The advantage of the Ilizarov technique is that it does not require an additional procedure for grafting and plating. However, there are reports indicative of higher pain scores associated with the Ilizarov method and conflicting reports concerning the level of complications associated with each technique.
Leg shortening
Leg shortening surgery is also performed under general anesthesia. Generally, femoral shortening is preferred to tibial shortening, as larger resections are possible. Femoral shortening can be performed by open or closed methods at various femur locations. The bone to be shortened is cut, and a section is removed. The ends of the cut bone are joined together, and a metal plate with screws or an inter-medullary rod down the center of the bone is placed across the bone incision to hold it in place during healing.
Epiphysiodesis
Epiphysiodesis is also performed under general anesthesia. The surgeon makes an incision over the epiphyseal plate at the end of the bone in the longer leg. He then proceeds to destroy the epiphyseal plate by scraping or drilling it to restrict further growth.
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These twin sisters are undergoing leg lengthening treatment. Their mother turns bolts on the external fixators of the leg to increase the distance between the two parts of the the surgically broken bone 1 millimeter a day. (Custom Medical Stock Photo. Reproduced by permission.)
To lengthen a leg surgically, an incision is made in the leg to access the femur (A). A surgical drill is used to weaken the femur so the surgeon can break it. During the operation, screws are drilled into the bone on both sides of the break, and an external fixator is applied (B). The gap between the two pieces of bone is increased gradually (C), so new bone growth results in a longer leg (D). (Illustration by GGS Inc.)
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Other Information
Leg lengthening and shortening are types of surgery to treat children who have legs of unequal lengths, usually with differences of 1 inch or more.
These procedures may:
Lengthen an abnormally short leg
Shorten an abnormally long leg
Limit growth of a normal leg to allow a short leg to grow to a matching length
BONE LENGTHENING
Lengthening an abnormally short leg may be recommended for children whose bones are still growing. This series of treatments involves several surgical procedures, a lengthy convalescence period, and considerable risks -- but it can add up to 6 inches of length to a leg.
While the child is under general anesthesia, the bone to be lengthened is cut. Metal pins or screws are inserted through the skin and into the bone.
Pins are placed above and below the cut in the bone, and the skin incision is stitched closed.
A metal device (usually some sort of external frame) is attached to the pins in the bone and will be used later to gradually pull the cut bone apart, creating a space between the ends of the cut bone that will fill in with new bone. The lengthening device is used very gradually to ensure adequate filling of the bone and stretching of the soft tissues.
Later, when the leg has reached the desired length and has healed (usually after several months), another surgical procedure will be done to remove the pins.
Because the pins or screws are inserted through the skin into the bone, special care of the pin sites is important to prevent infection. Also, because the blood vessels, muscles, and skin are stretched with each lengthening, careful and frequent checking of the skin color, temperature, and sensation of the foot and toes is necessary to prevent circulatory, muscular, or nerve damage.
BONE SHORTENING
Shortening a longer leg may be recommended for children whose bones are no longer growing. This is a technically complicated surgery that can produce a very precise degree of correction.
While the child is under general anesthesia, the bone to be shortened is cut and a section of bone is removed. The ends of the cut bone will be joined and a metal plate with screws or a nail down the center of the bone is placed across the bone incision to hold it in place during healing.
Because the blood vessels, muscles, and skin are involved, careful and frequent checking of the skin color, temperature, and sensation of the foot and toes is necessary to prevent circulatory, muscular, or nerve damage.
From http://www.nlm.nih.gov/medlineplus/ency/article/002965.htm
Other Information
Orthopedic complaints are the most common reason to seek medical care.
From: About.com
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