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What is Limb lengthening?
As the name suggests, it is lengthening of the limb( arm and leg) by distraction osteogenesis method, the people with limb length discrepancy due to many reasons injuries, fractures, and congenital or any other crush injury can get the benefit by this method. Distraction osteogenesis also has its limitations; the safe limit of lending is from 2 cm -6 cm, more than this limit is hard to correct the possible deformities but not impossible.
How it work?
Ilozarov used an external fixation device on patients to treat non union fractures in the 1950s.
The ilizarov external fixator can be used to correct angular deformities, to correct bone length differences and treat non union and compound fractures.
The device is a specialized form of external fixator, modular in construction. Stainless steel /titanium or carbon fibre rings are fixed to bone via stainless heavy gauge wire ( called pins or kirschner wires). The rings are connected to each other with threaded rods adjunct through adjustable nuts. The circular construction and tensioned wires of the ilizarov apparatus provide far more structural support than the traditional monolateral (monorail ) fixator system. This allows early weight bearing.
In this method the procedure consists of initial surgery in which bone to be lengthened is cut in the shaft( osteotomy) and an external fixator is placed. Timely distract the bone with the help of the frame screws.
Careful observation of the callus formation.
Once healing and lengthening is complete, a second surgery is necessary to remove the rings apparatus.
The procedure sounds minimally invasive but distraction osteogenesis ( lengthening) is a time taking procedure, the amount of lengthening is 1mm in a day (.25 each time/4 times a day),gives time to lengthen soft tissue,ligament and nerves as well which is as important as callus formation. Procedure sounds simple but it is not complication free. Pain is common and can be treated with pain medication. Physical therapy often indicated.
During this procedure minimal deformities like valgus or varus leg can be corrected too.
Type of lengthening
1. LON
Lengthening over nail-
Ilizarov frame is a heavy structure which causes pain and many other complications of keeping the frame longer, to reduce the complication and time of frame, the methods used called lengthening over the nail.
In conventional ilizarov method the frame must remain attached for the entire lengthening and the consolidation.
LON (Lengthening over nail) minimise the period of external fixator attachment.
In LON (Lengthening over nail) two surgeries needed, one is initial surgery for osteotomy, insertion of the intramedullary nail and fixation of the frame. The frame remains till the desired lengthening is done, one the distraction is complete second operation is done to remove the external fixator and lock (with screws) intramedullary nail . Patients will be allowed for early mobility and partial weight bearing with the help of crutch or walker during the consolidation period.
A combination of intramedullary nailing along with an external fixator significantly reduces the external fixation time while maintaining low complication rate.
The intramedullary nail is the prevention of axial deviation during the fixation period and also after removal of the fixator over the long term.
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