Whether due to health problems or aesthetic concerns, stature lengthening can be achieved through leg-lengthening surgery. Lengthening is an orthopaedic surgical procedure and it can be applied to legs as well as arms. The operation entails placing of external fixators to increase the space between the ends of the bones which are surgically cut with precision and divided into two. Day by day, the divided bone stretches in the slowly widening cavity and this leads the body to produce new bone structures. The process where the bones move away from each other and regenerate new bone structure is called distraction osteogenesis.
Stature lengthening does not require using bones from another part of the body as the idea in this operation is to benefit from the body’s ability to form new bones out of the existing structures.
If the planned extension is less than 8 cm, it is sufficient to perform a surgical procedure on one of the thigh or tibia. However, an elongation of more than 8 cm would require a procedure involving both of these bones. Length extension is conducted in stages and the process is much easier with the support of physiotherapy. Because the muscles, ligaments, nerves, vessels and other soft tissues are a part of the bones structure, these elements automatically adapt to the elongation process. Physiotherapy also facilitates the adaptation process of these systems.
Why Lengthening Surgery?
Lengthening surgery can be applied to anyone who is short in length due to genetic reasons or a number of diseases in childhood.
Also known as dwarfism, achondroplasia, for instance, is a problem of genetic origin and the only solution to this irregularity is length extension surgery.
On the other hand, some childhood diseases, nutritional and hormonal disorders and early kidney problems may also result in short stature.
When to Perform Lengthening Surgery?
Lengthening operations can be performed at as early as 3-4 years. For children, the number of operations is determined according to the calculated shortness. If the shortness rate of the patient is too high, the treatment is planned in two stages.
Types of Stature Lengthening Surgery
- Lengthening surgery can be divided into 3 different techniques:
- External fixation (Ilizarov technique)
- Internal fixation (Motorized nail)
- Combination of the two above
The somehow outdated Ilizarov technique, which involves external application to the leg, is now replaced by internal fixators that are inserted inside the limbs and controlled externally. Known as the motorized intramedullary nail technique, this operation simply requires a small incision. Lengthening can also be achieved by solely external devices (external application). The combined technique calls for extension through the use of external fixators with intramedullary nails.
Lengthening Surgery: The Process
First and foremost, it should be noted that lengthening surgery requires an orthopaedic surgeon who is experienced in this field. Although surgery is generally performed under general anaesthesia, epidural anaesthesia may suffice in some adults.
The initial step in the operation is to cut the bone that is planned for extension into two on a transverse plane. This is followed by stabilising the leg with fixing devices. The bone that has been cut is gently separated by the inserted device. This separation allows the bone to grow. After this initial procedure, the pins in the device are extended four times a day to a quarter millimetre at each adjustment, so that the new bone tissue can grow continuously, up to a total elongation of 1 millimetre per day. As the space between the ends of the bone widens, the body continues to fill in this space new tissues until the bone of the desired length is formed. Patients can walk on the leg on the first postoperative day.
The second stage of the treatment, referred to as the consolidation stage, initiates after the bone has hardened and healed. Now, patients can discontinue using the crutches. At this stage, the new bone tissue formed after recovery is fully restored and will soon be as strong as the other bones.
What Comes Next After the Lengthening Surgery?
- Patient are discharged on average 2 days after surgery.
- Patients have no serious pain problems and pain can be easily controlled with common painkillers.
- Surgical scar is minimal due to small incisions applied in lengthening surgery.
- The recovery time is different for each patient. Particularly, the second treatment stage may take longer in some adults while the healing process of children is half shorter.
- Physiotherapy support will shorten recovery time as keeping the joints flexible and increasing the strength of the muscles supports the healing process.
- Further, a balanced diet and calcium supplements are also helpful during the process.