Limb Lengthening Surgery

Limb lengthening surgery is a procedure done by surgeons to increase the size of the limb of the patient. Lengthening or straightening of the bone is done to improve function and allow normal alignment of the body. It uses the capability of the body to form new bones. The nerves, blood vessels and soft tissues stretch over a period of time to compensate for the increasing length. This process is formed at a very slow rate of 1 mm per day until the target is achieved. 

Children with legs of unequal legs may undergo limb lengthening and shortening surgeries. These procedures may help in shortening a significant long leg, lengthening a short leg, and also prevent the normal leg from growing so that the short leg grows and matches the normal leg. 

This process of Limb lengthening surgery is done to correct the following types of disorders.

1. Skeletal dysplasia: This is the type of birth defect in which there is a problem in the growth of bones. This condition results in crooked limbs.
2. Limb length discrepancy: In this condition, either one leg or one arm of the patient remains shorter than the other.
3. Growth plate injury
4. Non-union of the previous fracture: The previous fracture is not healed correctly and causes either curving or shortening of the limb.
5. Osteogenesis imperfecta: This is a genetic disorder. This bone becomes more fragile and becomes more susceptible to fractures. This problem can start in infancy.
6. Previous injuries or bone fractures that may stimulate excessive bone growth
7. The other diseases include Legg-Perthes disease, poliomyelitis and cerebral palsy.

 Limb lengthening surgery is performed to correct the limb length discrepancy. Delaying the surgery may result in several physical and psychological complications.

1. Walking with the limb length discrepancy may result in lumbar scoliosis and gait abnormalities.
2. It may also result in functional disturbances of the knee, hip, and ankle joints.
3. It is also a cosmetically disrobing disorder that may cause self-image issues in the patients.

Thus, delay in the lengthening surgery should be done as advised by the surgeon to avoid progressive complications.

An expert orthopaedic surgeon does the surgery of limb lengthening. It is generally performed in children. It is done in the following steps:

1. An anesthesiologist will give an injection of general anaesthesia to the patient.
2. After injection of general anaesthesia, the patient will not feel any pain.
3. A firm cut is made through the skin, and the device used for lengthening the limb is inserted into the limb.
4. Another firm cut is made to cut the bone. It is the site where the new bone will grow.
5. Then, the device used for lengthening is pushed through the sliced bone. 
6. Then, the lengthening device is fixed at its place with the help of screws. A magnet motor is also inserted. 
7. The working of the magnetic motor is checked by using a remote controller.
8. Then after this, the cuts are closed by the doctors using the sutures.
9. The surgical team will then sterilise the skin around the cut area to prevent infection. 

The orthopaedic surgeon may ask you to stop taking certain medicines before surgery. It is advised to prevent any kind of possible interaction with the anaesthesia and prevent excessive bleeding during the procedure. It is your responsibility also to inform the doctor about any over the counter medicine that you are taking. In addition, less stress and good mental and emotional health is prioritised because it is easier to recover after surgery if you are healthy.

1. The doctor may ask the patient to follow the following instructions before the surgery starts.
2. Doctors may ask you to remove jewellery from your body before the operation. Jewellery is removed for safety purposes to avoid any infection and accidents.
3. You will be recommended to wear loose clothes usually, a gown is provided by the hospital to wear in the operation theatre.
4. You have to undergo a detailed physical exam. The team will ask questions about the medical history of the patient. 
5. A needle is then injected into the hand to deliver the medicines and electrolytes.

1. The very first part of the procedure involves an osteotomy. In this step, the bone that is to be lengthened is cut.
2. Choosing the area to be cut depends on the region where the discrepancy occurs.
3. Then after this, the limb of the patient is stabilised with the help of the steel fixture.
4. The lengthening device is inserted between the loose end of the bones and fixed there with the help of a screw. All this happens under the influence of anaesthesia. Therefore, the patient will not feel any pain during the operation period. 

1. The patient may need your help after the surgery. 
2. The patient is kept in hospital for 1-2 days after surgery. 
3. Then shifted to a room dedicated to the patient. 
4. The patient is instructed not to put any kind of stress and weight on the operated limb. 
5. You should follow all the instructions given by the orthopaedic care team.
6. You need to clean the fixator pin sites every day to prevent infection. 
7. Take your child to the surgeon's appointment every week for regular check-ups of the lengthening device. 

First follow-up appointment

1. Frequent visits by the patient to the healthcare provider are required. In addition, it is needed to adjust the lengthening device.
2. The time of use of the lengthening device depends upon the amount of limb lengthening that is required. Physical therapy is advised to the patient by a doctor for maintaining a normal range of motion.
3. Special care is required to avoid the chance of infection by the screws used for tightening the lengthening device.
4. Frequent check-ups of skin colour sensation of foot and toes are required. It will help to find any kind of damage to blood vessels or muscles.
5. The doctor may prescribe opioid analgesic medicines to stop the pain caused after the operation.

You should immediately consult a doctor if you have started experiencing any of the following signs and symptoms. 

1. Persistent fever and chills.
2. Pain or swelling in feet, calves or legs.
3. Pain that is not cured by painkillers
4. Pain in the chest and shortness of breath.
5. Problems in your fixation device.
6. Severe nausea and vomiting
7. Numbness, tingling and loss of feeling in your leg or foot. 
8. Redness, swelling, pain, discharge and excessive bleeding from the incision site.