Limb lengthening Dubai to increase a person's stature in people who are proportioned normally and do not have dysplasia or dwarfism uses a strategy that differs from that used on patients with dysplasia and disproportion. The majority of patients with a relatively short stature will only need a rather modest stature increase in comparison to those with dwarfism.
Patients that have dwarfism are frequently treated when they are children, whereas people with a short stature are not treated until growth is complete. These types of patients do not normally have bone deformities. To keep the lengthening time to a minimum, a technique called lengthening and nailing or LATN is often used by MOSH orthopaedic surgeons. This technique keeps the length of time in an external fixator to a minimum, since this time will be reduced to the amount of time that is required for the lengthening process to be completed and it will not be needed during the consolidation or hardening phase. This technique also reduces the amount of time that is needed for rehabilitation and the amount of time it takes to be able to fully bear weight. However, a lengthening nail that is fully implanted is now available that eliminates the need for an external fixator completely, but this is a relatively new device.
A typical lengthening goal for short stature is 5 to 8 cm. A greater length cannot be safely achieved for a single pair of bones in a single lengthening. For additional lengthening the process must be repeated in an additional pair of bones.
Limb Lengthening techniques used at MOSH
The typical strategy involves lengthening both tibiae and the fibulae 5 to 8 cm using the LATN technique or an internal lengthening nail. If additional lengthening is desired then the bilateral femurs are lengthened. The majority of patients do not have their femurs lengthened due to the additional time and expense that is involved, which will rise two fold. Furthermore, excessive lengthening of the lower limbs in people who are proportioned normally will cause an obvious disproportion. Eight centimeters or less of lengthening will not result in a noticeable disproportion.
Limb lengthening Dubai orthopaedic surgeons at MOSH generally prefer tibial lengthening as opposed to femoral lengthening for a number of reasons. Lengthening of the tibiae makes a patient's legs appear longer than if the femurs were lengthened. This is because the level of the feet and knees are visually apparent but the hip level is not so obvious. In addition, tibia lengthening can be performed in a single operation in less time than a femoral lengthening which requires two set-ups that are separate during a single operation or two separate operations, which significantly increases the time it takes to perform the operation and the cost of the operation. Furthermore, the blood loss is far less with tibial lengthening as opposed to femoral lengthening and having bilateral external fixators on the lower legs is much easier for a patient to tolerate than bilateral femoral fixators.
The majority of patients at MOSH remain in the hospital approximately four days after their surgery. Physiotherapy, used to stretch the ankles, starts in the hospital and it is continued after the patient is discharged. Patients must have physiotherapy daily for one to two hours during the time of lengthening, which may be about three months. The range of motion of the ankle is a factor that can limit lengthening. The lengthening can proceed as long as the patient is able to stretch their foot greater than 90 degrees.
After discharge, patients will need to be seen by their MOSH orthopaedic surgeon at least once every two weeks. Nerve testing, pin examination, and x-rays are performed on these visits. Any problems will be identified and treated. The external fixators may also be adjusted during these visits.
How long does Lengthening take?
It will take approximately one month for every 2.5 cm of lengthening. Lengthening will not commence until about one week subsequent to surgery. Therefore, 8 cm of lengthening will take about three months of using an external fixator. Weight bearing is permitted within pain limits After lengthening is complete a second surgery is required to remove the external fixators and insert intramedullary nails. After the removal of the external devices, patients will need to visit their MOSH orthopaedic surgeon monthly.
What kind of follow up care is needed?
Patients will not be permitted to bear any weight on their legs until X-rays indicate that the bone is sufficiently healed to allow the patient to bear weight on them. This normally takes between one and two months subsequent to nail insertion. Physiotherapy will continue primarily to regain full motion of the ankle and foot strength for pushing off. This will take several additional months. It is recommended that the rods be removed in the future. This is not crucial and it can be performed at any time after the bones have healed fully. This is usually done one year after the lengthening process is complete.