The exciting science of Limb lengthening is explained in simple terms. Common causes of limb shortening, methods of exact measurement of shortening are described. The nature of Limb Lengthening surgery with some of its common complications is described and also the experience of our centre till 2007.
Our center has one of the largest experiences in the world in Pediatric Limb Lengthening for all kinds of conditions like Birth defects, congenital anomalies, deformities caused by Osteomyelitis and Growth Arrest etc. Strategies are discussed and Tips & Pearls are given.
Biology of Limb Lengthening
Understanding the Biological basis of Limb lengthening is fundamental to getting reliable lengthening. The law of Tension Stress laid down by Prof Ilizarov helps us understand the process. The Seven Rules of lengthening are crucial to achieving reliable lengthening. The type and location of corticotomy, the soft tissue tension, effect of age and percentage lengthening all have various effects on regenerate formation.
Rule 1 of deformity correction applies when the hinges are placed on CORA & the osteotomy is performed at apex of deformity. More commonly Rule2 applies in metaphyseal deformities and juxta-articular deformities where the osteotomy is performed away from CORA. This creates a necessary translation at osteotomy site, but this helps the overall mechanical axis to line up perfectly. This talk explains how to achieve the translation either using real hinges or using Virtual hinges to achieve full correction of the mechanical axis.
LON vs LEF Comparison of two common lengthening methods
While lengthening with implantable lengthening devices is considered state-of-the-art, these devices are expensive and not easily available. They are also not indispensable. We use the external fixation lengthening methods with great success over the last 29 years and have used LON or Lengthening over nails method since the last 23 years. in this study we compare the two methods in terms of time of external fixation, time taken to unite, amount of length gain and complications.
Upper femur lengthening in trauma cases has been studied by us in 52 cases in great detail. We find that bone formation is excellent even in these very difficult cases. The only problems were related to Axial Deviation.