Type of Surgery
Information
Last updated: 11/24/2009
BOOKS
Golyakhovsky, V. and V. H. Frankel. Operative Manual of Ilizarov Techniques. Chicago: Year Book Medical Publishers, 1993.
Maiocchi, A. B. Operative Principles of Ilizarov: Fracture, Treatment, Nonunion,...
Osteomyelitis, Lengthening Deformity Correction. Phildalephia: Lippincott, Williams & Wilkins, 1991.
Menelaus, M. B., ed. The Management of Limb Inequality. Edinburgh: Churchill Livingstone, Pub., 1997.
Watts, H., Williams, M. Who Is Amelia?: Caring for Children With Limb Difference. Rosemont, IL: American Academy of Orthopedic Surgeons, 1998.
PERIODICALS
Aarnes, G. T., H. Steen, P. Ludvigsen, L. P. Kristiansen, and O. Reikeras. "High frequency distraction improves tissue adaptation during leg lengthening in humans."Journal of Orthopedic Research 20 (July 2002): 789–792.
Barker, K. L., A. H. Simpson, and S. E. Lamb. "Loss of knee range of motion in leg lengthening."Journal of Orthopedics Sports and Physical Therapy 31 (May 2001): 238–144.
Bidwell, J. P., G. C. Bennet, M. J. Bell, and P. J. Witherow. "Leg lengthening for short stature in Turner's syndrome."Journal of Bone and Joint Surgery (British) 82 (November 2000): 1174–1176.
Choi, I. H., J. K. Kim, C. Y. Chung, et al. "Deformity correction of knee and leg lengthening by Ilizarov method in hypophosphatemic rickets: outcomes and significance of serum phosphate level."Journal of Pediatric Orthopedics 22 (September-October 2002): 626–631.
Kocaoglu, M., L. Eralp, A. C. Atalar, and F. E. Bilen. "Correction of complex foot deformities using the Ilizarov external fixator."Journal of Foot and Ankle Surgery 41 (January-February 2002): 30–39.
Lee, S. H., G. Szoke, and H. Simpson. "Response of the physis to leg lengthening."Journal of Pediatric Orthopedics 10 (October 2001): 339–343.
Lindsey, C. A., M. R. Makarov, S. Shoemaker, et al. "The effect of the amount of limb lengthening on skeletal muscle."Clinical Orthopedics and Related Research 402 (September 2002): 278–287.
Nanchahal, J. and M. F. Pearse. "Management of soft-tissue problems in leg trauma in conjunction with application of the Ilizarov fixator assembly."Plastic and Reconstructive Surgery 111 (March 2003): 1359–1360.
ORGANIZATIONS
American Academy of Orthopedic Surgeons. 6300 North River Road, Rosemont, Illinois 60018-4262. (847) 823-7186.
American College of Foot and Ankle Surgeons. 515 Busse Highway, Park Ridge, Illinois, 60068. (847) 292-2237. (800) 421-2237.
OTHER
"Epiphysiodesis." Institute of Child Health. [cited April 2003].
"Ilizarov Method." Northwestern orthopedics. [cited April 2003].
"Leg lengthening/shortening." MedlinePlus. [cited April 2003].
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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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