{"id":328,"date":"2019-08-02T22:46:04","date_gmt":"2019-08-02T20:46:04","guid":{"rendered":"https:\/\/radler-ortho.com\/?page_id=328"},"modified":"2022-01-25T15:35:18","modified_gmt":"2022-01-25T14:35:18","slug":"beinverlaengerung","status":"publish","type":"page","link":"https:\/\/radler-ortho.com\/en\/erwachsene\/beinverlaengerung\/","title":{"rendered":"Limb Lengthening"},"content":{"rendered":"\n

If a patient has\ndifferent limb lengths (limb-length discrepancy) because of an injury, a\nmalunited fracture, or a congenital deformity, limb lengthening can be\nperformed.<\/p>\n\n\n\n

\"Beinverl\u00e4ngerung<\/figure><\/div>\n\n\n\n

Limb-length\ndiscrepancy leads to an inclination of the pelvis, asymmetry of the spine, and\nunbalanced loading at the connecting joints of the pelvis to the spine. On the\nlonger limb, the hip is less covered, which can lead to early arthritis. The limb\ncan develop varus (bowleg) malalignment. These changes are more problematic the\nbigger the limb-length discrepancy is. Therefore, correction of limb-length\ndiscrepancy of more than 2 cm is usually recommended. <\/p>\n\n\n\n

Treatment<\/strong><\/h2>\n\n\n\n

Limb lengthening can be performed using an intramedullary lengthening nail<\/a>, such as the Precice nail (NuVasive, Inc., San Diego, California, USA). In certain complex cases, a six-axis external fixation frame, such as the Taylor spatial frame (Smith & Nephew, Memphis, Tennessee, USA) is required. <\/p>\n\n\n\n

For intramedullary limb lengthening, a lengthening nail is implanted into the femur (thigh bone) or tibia (shin bone). The bone is osteotomized (cut) during surgery. Using an external remote control, the two parts of the lengthening nail<\/a> can be distracted slowly and gradually, usually at a speed of 0.75 to 1 mm per day. In the distraction gap, new bone forms (callus distraction). After distraction, the new bone becomes hard and remodels until it is stable. <\/p>\n\n\n\n

\n
\n
\"Precice
Phase 1: Implantation of the nail and osteotomy of the femur (Picture: OSS)<\/figcaption><\/figure>\n\n\n\n
\"Precice
Phase 3: New bone is forming in the distraction gap (Picture: OSS)<\/figcaption><\/figure>\n<\/div>\n\n\n\n
\n
\"Precice
Phase 2: Distraction of the lengthening nail and callus (Picture: OSS)<\/figcaption><\/figure>\n\n\n\n
\"Precice
Phase 4: The bone has healed and remodeled, and the nail has been removed (Picture: OSS)<\/figcaption><\/figure>\n<\/div>\n<\/div>\n\n\n\n

Simultaneous realignment and deformity correction<\/a> are possible with the lengthening nail, using specific advanced techniques such as fixator-assisted nailing. <\/p>\n\n\n\n

In addition to\nlengthening of the femur (thigh bone), the Precice nail can be used for\nlengthening of the tibia (shin bone).<\/p>\n\n\n\n

\n
\n
\"Tibia
Lengthening of the tibia using a Precice nail (front view)<\/figcaption><\/figure>\n<\/div>\n\n\n\n
\n
\"Tibia
Lengthening of the tibia using a Precice nail (side view)<\/figcaption><\/figure>\n<\/div>\n<\/div>\n\n\n\n

Some complex or severe deformities cannot be corrected acutely with plates and nails, especially if doing so would mean danger to the skin, nerves, or blood vessels. The same is true for bones with active infection. In those cases, correction can be achieved using external fixation<\/a>. <\/p>\n\n\n\n

I have 20 years\u2019 experience with Ilizarov surgery and modern computer-guided six-axis external fixation frames<\/a>, such as the Taylor spatial frame<\/a> (Smith & Nephew, Memphis, Tennessee, USA). This frame allows simultaneous gradual correction<\/a> of bone shortening, rotation, and angulation in all planes. <\/p>\n\n\n\n

The bone is cut minimally\ninvasively through a 10- to 15-mm skin incision by creating multiple drill\nholes and connecting them with a small chisel. Approximately 1 week after\nsurgery, the distraction of the newly forming bone and the correction of the\ndeformity are begun. The distraction amount is usually up to 1 mm per day,\ndepending on patient age, area of correction, and bone quality. <\/p>\n\n\n\n

In all cases of limb\nlengthening, physical therapy plays a vital role. Physical therapy and\nstretching exercises must be performed daily to allow the muscles and tendons\nto grow the same way the bone does. Additionally, the range of motion of the\njoints must be preserved throughout the lengthening process. <\/p>\n\n\n\n

Mobilization is started on the first or second day after surgery. Partial weight-bearing is almost always possible with the use of crutches. Approximately 2 weeks after surgery, showering with an external fixation <\/a>frame without the need to cover it is possible. At the end of lengthening, as soon as some bone can be seen in the distraction gap on x-rays, full weight-bearing can commence. <\/p>\n","protected":false},"excerpt":{"rendered":"

If a patient has different limb lengths (limb-length discrepancy) because of an injury, a malunited fracture, or a congenital deformity, limb lengthening can be performed. Limb-length discrepancy leads to an inclination of the pelvis, asymmetry of the spine, and unbalanced loading at the connecting joints of the pelvis to the spine. On the longer limb, … Continue reading Limb Lengthening<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":20,"menu_order":2,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"translation":{"provider":"WPGlobus","version":"2.12.2","language":"en","enabled_languages":["de","en"],"languages":{"de":{"title":true,"content":true,"excerpt":false},"en":{"title":true,"content":true,"excerpt":false}}},"amp_enabled":true,"_links":{"self":[{"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/pages\/328"}],"collection":[{"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/comments?post=328"}],"version-history":[{"count":17,"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/pages\/328\/revisions"}],"predecessor-version":[{"id":4127,"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/pages\/328\/revisions\/4127"}],"up":[{"embeddable":true,"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/pages\/20"}],"wp:attachment":[{"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/media?parent=328"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}