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Limb Lengthening

Limb lengthening is carried out to correct problems caused by having legs of different lengths, including as a result of an accident, as well as to grow new bone for people who want to be taller (including people who are born with conditions that result in them being exceptionally short in stature). It’s often carried out at the same time as lower limb deformity correction.

What does the procedure involve?

During limb lengthening surgery, the bone is cut and separated using an external or internal ‘fixator’, or frame, which is attached to the bones.

An external fixator is like a frame that supports the separated bones and can be slowly adjusted over a period of time to lengthen the limb by pulling the bones and tissue apart, which results in new growth. This process is known as ‘distraction’ and it typically involves growth of around a millimetre per day.

Internal fixators consist of a telescopic rod that is implanted inside the centre of the bone and, using an external remote control, is gradually lengthened.

Limb lengthening is carried out in two phases: distraction and consolidation.

  • Distraction phase: the bone and soft tissue are parted and slowly pulled apart
  • Consolidation phase: once the correct bone length has been reached, time is allowed for the new bone to harden enabling you to gradually put more weight on it and walk without crutches

Before surgery

You can help improve the outcome of surgery by attending a pre-assessment screening where you’ll have blood tests to check for levels of Vitamin D and swabs to rule out infection or other problems. You’ll also be weighed and have an opportunity to discuss your medical history. This is important so that any anaesthetics problems can be identified.

Please note: it’s important to stop smoking at least eight weeks before your procedure; this is because smoking can affect the body’s ability to heal and causes health problems including an increased risk of blood clots forming in the lungs (pulmonary embolism) or calf (deep vein thrombosis).

What happens after surgery?

Most people stay in hospital for a few days and you’ll begin working with one of our physiotherapists on a rehabilitation plan the day after your surgery. This involves carrying out a programme of exercises every day, and is essential for your treatment to be effective.

The lengthening process usually begins a few days after your surgery, allowing time for new bone to form where the bones have been broken (the latency period). You’ll be shown exactly how to lengthen the bone each day by turning the fixator a set number of times.

  • Once the bone has reached the target length, no more adjustments are made to the fixator but it will stay in place to allow the bone to harden
  • For each 1 cm of bone lengthening the frame will stay on the leg for up to 60 days, so for a 4cm lengthening, the limb will typically be in the frame for 8 months
  • You’ll have regular X-rays to check that the new bone has healed correctly before the fixator is removed

What are the potential problems with this type of surgery?

If the gap between bone and tissue is increased too quickly, new bone may not grow and there can be long term problems caused by nerve and tissue damage. However, if the gap is increased too slowly, the bones can join too quickly (premature consolidation) which prevents the limb lengthening any further. It’s important to follow any advice about how much to turn the fixator each day.

What can I do to speed up my recovery?

Raising your leg above the level of your heart and keeping weight off the foot as much as possible during the first few days can help with recovery. Make sure you follow any advice about keeping the wound clean and dry, and carry out the exercises advised by your physiotherapist as these will help you to return to your normal activities as quickly as possible.

Please note: it’s important to avoid smoking or taking anti-inflammatory painkillers as these can slow the healing process.

What are the risks of surgery?

  • All surgery carries risks. With this type of surgery, risks include a small chance of infection which can be treated with antibiotics
  • There is a small chance of deep vein thrombosis (DVT) following any surgery, although this is unusual following this type of surgery. However, you may be given blood-thinning medication after surgery as a precaution or if you are at higher risk. You will also be given support socks and exercises to reduce the chances of DVT