Limb lengthening

Specialty of Orthopaedic surgery

What is bone elongation?

Better known as limb lengthening (tibia, femur and humerus), bone elongation covers a range of surgical techniques aimed at increasing the length of a bone segment. Usually it is done by techniques which involve cutting the bone (osteotomy and corticotomy) and progressively extend the reparative callus which occurs in the normal body repair attempt. To perform this progressive lengthening is necessary to use extraosseous mechanical devices (external fixation systems) or intraosseous (intramedullary nail), implantation of such devices can be done under local anaesthesia.

Why is it done?

Bone elongation is performed bilaterally in all cases of stunting and, unilaterally, in cases of limb disparity. In the first case, it is applied to facilitate the patient’s relationship with their environment while in unilateral cases the goal is to achieve the desired length to prevent shortening of limbs, which can cause spinal pathologies, alterations when walking and lameness.

What does it consist of?

It consists of the extension of a tubular bone, femur, tibia and / or humerus to the desired length to prevent shortening of limbs or short sizes. The procedure is carried out in the shortened bone and it involves creating a fractured bone. The new bone starts to regenerate and “stretch”.

Preparation for bone elongation

It is essential that the patient is informed of all the particulars of the technique. You must also know the different times and possible complications that can occur and their solutions. On long stretches it should also be carried out other specific techniques on muscles and tendons to avoid creating rigidities and joint deformities.

Care after surgery

Once the reconstruction system is installed and the bone fragments are transported (stretched), the limb must remain without any load during the "active" phase. In this phase, a new soft callus is produced to heal the fracture and this tissue must be protected from applying any pressure. Once this phase is finished, the "static" phase begins, which is that phase in which the new tissue matures and ossifies. When the degree of ossification allows it, the patient can stand on the legs. Throughout the process, the cutaneous orifices of the skeletal fixation screws that attach the bone to the external device must be meticulously taken care of. The use of endomedullary elongation nails has its limitations and easements but requires less care. Both systems require close clinical and radiographic control.

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