LIMB SHORTNESS

REASONS FOR EXTREMITE LENGTH SHORTNESS

Congenital diseases, leg length difference after growth plate damage, leg height difference after previous fractures can develop. As a result of the measurements made in the normal population, a shortness of 2 cm was accepted as normal. The majority of people do not realize this shortness. This level of shortness also does not need to be treated. If the person is uncomfortable with this difference, the insoles placed in the shoes are the solution for the patients. People with leg length inequality more than 2 cm should be lengthened with short leg lengthening surgeries.

EXTREMITY EXTENSION TREATMENT

Limb lengthening is the process of gradually growing bone. Limb lengthening is used to correct limb length discrepancies and congenital short stature and is often combined with limb deformity correction. It is generally applied to people who have short stature due to limb lengthening, shortness of one leg as a result of an accident, congenital differences from the length of the legs, and some hereditary diseases.

Limb lengthening is performed with the method of “distraction osteogenesis” (the extension of the soft bone tissue (calus) formed during the healing period of the controlled fracture in the bone by 1 mm stretching method per day and the formation of normal bone tissue after the lengthening is completed). Extranal fixators were used to stretch the callus tissue. In order to reduce complications, the extension method over the nail placed in the bone (LON) was developed. Today, limb lengthening can be done more comfortably with extensible nails placed completely inside the bone.

MAGNETIC EXTENDABLE INTRAMEDULLARY NAIL

Precice brand nails are placed inside the bone. These intramedullary nails are elongated with the externally applied magnetic field, and as a result, lengthening is provided in the bone and extremity. Magnetic field is applied 3 times a day and 1 mm elongation is provided. Since 0.33 mm elongation is provided each time, the extension does not cause pain. The nail does not allow load bearing. For this reason, the required elongated extremity is not loaded until the bone is formed. In studies, 1.12 (0.87-1.71) months are required for bone formation at 1 cm elongation. For example, for 5 cm lengthening in the femur (thigh bone), the leg is not loaded for 5-6 months on average.

Source: Use of a magnetic bone nail for lengthening of the femur and tibia. Karakoyun O, Sokucu S, Erol MF, Kucukkaya M, Kabukçuoğlu YS.

MECHANICALLY EXTENDABLE INTRAMEDULLAR NAIL

Unlike magnetic extensible intramedullary nails, in mechanically extensible intramedullary nails, the patient performs certain exercises (such as turning the leg 9 degrees) during the day to provide leg lengthening. Bone formation time is the same as with magnetic intramedullary nails.

Source: Intramedullary skeletal kinetic distractor in lower extremity lengthening. Karakoyun O, Küçükkaya M, Sökücü S.

LEG EXTENSION WITH THE COMBINED METHOD

There are 3 stages in bone lengthening. Waiting time for callus to form in the first 5-7 days. Stage 2 is the extension stage and Stage 3 is the bone formation stage. In the combined lengthening technique, the first 2 stages are performed with a fixator, and in the 3rd stage, the fixator is removed and completed on the normal intramedullary nail placed in the surgery. Thus, the stay of the fixator on the patient is shortened. It is a more economical method in terms of money compared to intramedullary extensible nails. Bone formation time is the same as other methods.

Source: Lengthening over a retrograde nail using 3 Schanz pins. Kucukkaya M, Karakoyun O, Kuzgun U.

FIXATORS

Historically, Ilizarov's external fixator method has an important place in limb lengthening. In this method, bone lengthening is performed with the help of a fixator system placed outside the bone. Extensions are performed with external fixators, as intramedullary nails cannot be used due to infection in some bones, very high degrees of curvature, and the thinness of the bone. Today, this method is used especially if lengthening will be done with the correction of deformity (curvature). The important feature of this method is that the patient can bear weight in the early period.

If the fixator stays on the patient for a long time, infection may develop at the insertion site of wires and nails, and patients do not want to live with the fixator for a long time. For these reasons, the combined lengthening technique has been developed to shorten the fixation time. In this technique, intraosseous nails used in normal fractures are inserted into the bone. Fixator is placed outside the body. After the lengthening with the fixator is completed, the screws of the intramedullary nail placed in the bone are locked and the fixator is completely removed. In the process of turning soft bone into hard bone, this intraosseous nail carries the body. Thus, the fixator remains on the patient only during the lengthening period.

This method carries a risk of infection compared to leg lengthening with magnetic extensible nails. But it is more economical than other methods.

AFTER EXTREMITY EXTENSION TREATMENT

In limb lengthening; It is done by gradual lengthening of skin, muscle, blood vessels, nerves and bone. When soft tissues are slowly stretched and pulled, the body produces new soft tissue. Generally, soft tissues are lengthened 1mm per day. When rapid extension is performed, bone formation is delayed or does not occur, tension occurs in the muscles, and nerve damage may occur. Bone union may be premature if slower lengthening is performed. Limb lengthening occurs in two phases. The first is the extension phase. During this period, the bone is lengthened. After the extension is completed, the second phase starts. In the second stage, it is waited for the hardening of the bone.

Meticulous surgical technique, close follow-up of the patient, and serious physical therapy and rehabilitation are required for successful lengthening.

Lengthening surgery has many potential complications. Most complications can be completely reversed without surgery or with surgery. Complications should be treated very seriously and the patient should return to normal life. Therefore, the results of elongation are very dependent on the experience of the surgeon. A more experienced surgeon not only knows why to perform the surgery better, but also knows how to prevent and treat complications so that at the end of the treatment it is no longer a problem.

Limb lengthening is the process of gradually growing bone. Limb lengthening is used to correct limb length discrepancies and congenital short stature and is often combined with limb deformity correction. It is generally applied to people who have short stature due to limb lengthening, shortness of one leg as a result of an accident, congenital differences from the length of the legs, and some hereditary diseases.

In limb lengthening; It is done by gradual lengthening of skin, muscle, blood vessels, nerves and bone. When soft tissues are slowly stretched and pulled, the body produces new soft tissue. Generally, soft tissues are lengthened 1mm per day. When rapid extension is performed, bone formation is delayed or does not occur, tension occurs in the muscles, and nerve damage may occur. Bone union may be premature if slower lengthening is performed. Limb lengthening occurs in two phases. The first is the extension phase. During this period, the bone is lengthened. After the extension is completed, the second phase starts. In the second stage, it is waited for the hardening of the bone.

Meticulous surgical technique, close follow-up of the patient, and serious physical therapy and rehabilitation are required for successful lengthening.

Lengthening surgery has many potential complications. Most complications can be completely reversed without surgery or with surgery. Complications should be treated very seriously and the patient should return to normal life. Therefore, the results of elongation are very dependent on the experience of the surgeon. A more experienced surgeon not only knows why to perform the surgery better, but also knows how to prevent and treat complications so that they are no longer a problem at the end of the treatment.

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Oscar Ville Ofisleri
No:26/1 Tekirdağ Merkez

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