Type of Surgery
Information
Last updated: 11/24/2009
All the risks associated with surgery and the administration of anesthesia exist, including adverse reactions to medications, bleeding and breathing problems.
Specific risks associated with LLD surgery include:
- osteomyelitis (bone...
infection) - nerve injury that can cause loss of feeling in the operated leg
- injury to blood vessels
- poor bone healing (non-union)
- avascular necrosis (AVN) of the femoral head as a result of vascular damage during surgery
- chondrolysis (destruction of cartilage) following insertion of rods and pins
- hardware failure, failure of epiphysiodesis, failure of slip progression
- unequal limb lengths if one leg fails to heal properly (The physician may need to reverse the direction of the external fixator device to strengthen it, causing a slight discrepancy between the two legs.)
- joint stiffness (contractures) may occur during lengthening, especially significant lengthenings
- pin loosening in the anchor sites
Another serious specific risk associated with leg lengthening/shortening surgery is infection of the pins or wires going through the bone and/or resting on the skin that may result in further bone or skin infections (osteomyelitis, cellulitis, staph infections).
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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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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
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New procedures like minimally invasive procedures are often subject to scrutiny, but I think that one of the biggest problems facing these innovative procedures is for people to understand exactly what we do.
-Dr. Michael Perry, Laser Spine institute
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