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Lengthening FAQs


  1. What Is Lengthening?
  2. What is the cause of a short bone?
  3. How Do You Do Lengthening?
  4. What is an external fixator?
  5. What Is Orthofix Fixator And Ilizarov Fixator?
  6. How Long Does It Take?
  7. How long the fixator is kept?
  8. Do I Have To Be On Bed rest?
  9. When Can I Get Back To Normal Life?
  10. Are There Any Complications?
  11. How Do I Take Care Of The Fixator?
  12. The fixator time seems to be too long, is there any way of shortening it?
  13. What Is LON?
  14. What is LATN?
  15. Are LON & LATN Safe?
  16. Is LON/LATN Better than the external fixator?
  17. How Will I Know If I Can Or Cannot Have LON/LATN?
  18. Is The Lengthening Painful?
  19. It All Sounds So Complicated. Will I Be Able To Manage?
  20. Which Cases Do You Do A Lengthening?
  21. I Have Shortening In The Femur, And A Doctor Told Me To Have A Lengthening In The Tibia.
  22. My Leg Is Bent As Well As Short, Can Both Be Corrected Together?
  23. Will It Leave A Lot Of Scars?
  24. Can The Scars Be Removed By Plastic Surgery?
  25. How Do You Cut The Bone?
  26. Is It A Large Incision?
  27. Will I Need A Blood Transfusion?



Q. What Is Lengthening?
A. Lengthening is the term given to the surgical elongation of the bone.  
   
Q. What is the cause of a short bone?  
A. The causes are many but naming a few - anatomical deficiencies, congenital, traumatic, or as a result of disease.  
   
Q. How Do You Do Lengthening?  
A. Bone lengthening is a surgical procedure. It can be an acute or gradual process. Acute lengthening involves the surgeon making a cut in the bone and moving the bone into its new position. The bone is held in place with metal ware (plates and screws), also known as internal fixation. Gradual lengthening is the process where the bone is cut and the cut ends of the bone are pulled apart (called distraction), using an external device called external fixator.  
   
Q. What is an external fixator?  
A. It is a device, which is attached to the limb with metal pins and wires holding the bone in place.  
   
Q. What Is Orthofix Fixator And Ilizarov Fixator?  
A. Orthofix is a type of monolateral fixator, i.e. it is applied only one side of the limb. Ilizarov fixator is a circular or ring fixator, i.e. it surrounds the limb all around.  
 
Q. How Long Does It Take?  
A. In the gradual lengthening process the rate at which the distraction is done is 1mm/ day.  
   
Q. How long the fixator is kept?  
A. The rule of thumb for how long the frame needs to stay on is 30 days for every cm of length gained. This includes 10 days of lengthening to gain 1 cm, and 20 days of consolidation for every cm gained, or as we like to say “total fixator time is double the time it takes for the distraction to complete” e.g. for a 3 cm gain in length it takes 1 month to gain the length and 2 months for the bone to consolidate. This is a rough guide, as every person forms new bone at varying rates, and many factors can influence the length of treatment.  
   
Q. Do I Have To Be On Bed rest?  
A. Not really, we recommend a day’s rest and generally the bedside mobilization starts from the next day onwards. We also recommend what is called touch down weight bearing walking with the aid of a walker or a pair of crutches.  
   
Q. When Can I Get Back To Normal Life?  
A.

In terms of walking, touch down weight bearing with the aid of a walker or pair of crutches starts next day from the surgery. This progresses to partial weight bearing on completion of distraction. Thereafter its a gradual increase in weight bearing as tolerated. In the cases of unilateral lengthening, back to work (desk job, commuting small distances in own vehicle) with the fixator is allowed around 2-3 weeks from surgery. Patients undergoing bilateral lengthening would have to wait till the fixator comes off. A wheelchair can be used otherwise if required. Once the fixator comes off and the bone has healed well gradual resumption of activities is what we recommend. Walking, swimming, cycling, light weight training can be resumed immediately. Contact sports can be resumed in six months to an year depending on person to person.

 
 
Q. Are There Any Complications?  
A.

Pin tract infection or irritation is the most common complication, and this occurs in almost 60-80% patients. Most of these are superficial infections and require an oral antibiotic at the most. 1-2% of these may require further intervention like change of pin site, or surgical debridement and curretage.

Contractures or stiffness of adjacent joints e.g. Knee joint in case of femoral lengthening and ankle joint in case of tibial legthening, is a possible complication which we feel is entirely avoidable if the patient follows the instructions properly regarding the exercises. In the cases where it does happen, most of the patients recover well with physiotherapy. In rare circumstances a surgical release may be required.

Nerve injury is not unheard of, but is less common in the gradual lengthening method. Delayed union, deep infection, compartment syndrome are other rare potential complications.

 
   
Q. How Do I Take Care Of The Fixator?  
A.

All you have to do is boil about 1 liter of water for half an hour (half an hour is counted once the water starts to boil and not from the time it is kept on the stove/ gas/electric heater). Also boil a small steel bowl along with this. Once that is done let it cool down.

Now when you are ready for the dressing wash your hands and wrist thoroughly using tap water and soap. Use a clean, fresh towel to dry your hands.

The next step is to remove the dressings tied around the pins.

Once that is done, take some of the previously boiled and cooled water in the steel bowl (also previously boiled and cooled). Take a sterile gauze piece (this is the only dressing material which needs to be bought from the chemist), and dip it in boiled and cooled water. Use the wet gauze piece to clean the pin and the skin around it. Hold the gauze piece from its two ends and move it to and fro like we shine the shoes. Clean all sides thoroughly and discard the gauze piece. Take new gauze for every pin and clean them all.

After cleaning them all just tie a dry gauze piece around the pins. You can use one gauze piece to tie around nearby two or three pins. This prevents any fluid that comes out to stain your clothes.

In the initial 5 – 7 days, you may soak the gauze piece in betadine solution, but usually after that, dry gauze piece suffices.

 
   
Q. The fixator time seems to be too long, is there any way of shortening it?  
A. Yes, there are two ways of reducing this - LON(lengthening over nail) & LATN(lengthening and then nailing).  
   
Q. What Is LON?  
A. Lengthening over Nail i.e. bone lengthening done over an intramedullary nail. In this procedure an intramedullary nail is inserted in the bone; an external fixator is also applied; the bone is cut and distraction is done using the fixator while the nail is still inside the medullary canal – that is why the name lengthening over nail. Once the distraction is over the nail is locked and the fixator can then be removed.  
   
Q. What is LATN?  
A. Lengthening and then Nailing is the procedure where an external fixator is applied; the bone is cut and distraction is done. Once distraction is completed another surgery is done in which an intramedullary nail is inserted and the fixator is removed.  
   
Q. Are LON & LATN Safe?
A. LON/LATN carry a slightly higher risk of infection and pulmonary embolism as compared to external fixation alone; otherwise they are quite safe.  
   
Q. Is LON/LATN Better than the external fixator?  
A.

LON/LATN have definite advantages in terms of early fixator removal; hence improved patient comfort, reduced consolidation time; hence faster resumption of normal activities and reduced risk of refracture through the regenerate bone because of the protective effect of the nail.

 
   
Q. How Will I Know If I Can Or Cannot Have LON/LATN?  
A. If the growth plates are still open then the patient cannot undergo this surgery. If the intramedullary canal is not large enough for the nail, then also the surgery cannot be done. If a patient has a deformity and shortening together, then first correction of the deformity and lengthening are done by the external fixator and then nailing can be done (LATN).  
 
Q. Is The Lengthening Painful?  
A. Its not absolutely painless, but we call it discomfort. In the initial post-operative days the pain is from the surgery and it is taken care by medication. During distraction there may be pain on some days, like a stretch pain or an ache – these are generally taken care of by medication, at the most may need a day or two of rest. The consolidation period is largely pain free.  
   
Q. It All Sounds So Complicated. Will I Be Able To Manage?  
A. It is not rocket science as we tell our patients. While you are in the hospital we take care to simplify the procedure for you. In the initial days we shall show the things to you, then we observe and supervise you, making sure that you have learnt the proper care and exercises. Only when we are sure that you have learnt it well we discharge you. Even then we keep you under regular followup and are always reachable on phone or email to clarify any queries or doubts you may have. We do get lot of out of station patients, and all of them have had trouble free procedures.  
   
Q. Which Cases Do You Do A Lengthening?  
A. There are various causes for a short bone, they all cannot be named here for the lack of space but to name a few - post traumatic shortening, congenital deformities and shortening, developmental deformities, growth plate abnormalities, stature lengthening (cosmetic lengthening).  
   
Q. I Have Shortening In The Femur, And A Doctor Told Me To Have A Lengthening In The Tibia.  
A. We recommend lengthening of the same bone, which is short. Tibia is the most commonly lengthened bone as also is the easier of the two to be lengthened.  
   
Q. My Leg Is Bent As Well As Short, Can Both Be Corrected Together?
A. Yes, both can be done simultaneously with the help of the external fixator.  
   
Q. Will It Leave A Lot Of Scars?  
A. There will be small scars of the pins and additional scars from where the bone is cut – two in the case of tibia and fibula, one in the case of femur. There may be the scar of the entry point of the nail in the case of LON/LATN.  
   
Q. Can The Scars Be Removed By Plastic Surgery?  
A.

Yes, the scars can be made to look better by plastic surgery.

 
 
Q. How Do You Cut The Bone?  
A. The bone is cut using an instrument called the osteotome.  
   
Q. Is It A Large Incision?  
A. It is about 1.5-2 cm, just enough to let us pass the instuments to cut the bone.  
   
Q. Will I Need A Blood Transfusion?  
A. No. Since the surgery is done through small incisions, there is hardly enough blood loss to warrant a transfusion.  
     
  I Have Told That Pinsite Infection Is A Problem With Lengthening
  Can I Go To Work While The Lengthening Is Going On