Bone lengthening and deformities

Current Treatments for Lower Limb Length Discrepancies in Patients Available at Shriners Hospital

We had the opportunity to interview Dr. Daniela Velazquez, who studies pediatric orthopedics as her subspecialty here at Shriners Hospital. In this interview, she explains about the treatments that are currently available for lower limb length discrepancies in patients at Shriners Hospital, as well as procedures and times in which the treatment is carried out. At the bottom, you can find the video with the full interview.

What is done in the lengthening clinic?

This clinic treats patients with discrepancies in the length of the lower limbs and angular deformities in the same area. External fixators are used to correct this type of deformity since their advantages are multiple.
- The incision to place the external fixators are very small, which sometimes allows them to be placed bilaterally.
- It allows for a speedy recovery. The patient is encourages to begin walking as soon as possible as this helps the bone to heal, which makes recovery faster.
- The apparatus can be removed in the office without the need for an extra surgical procedure.

Treatments

“The idea is to use these methods as a reconstruction and avoid amputation procedures.”

There are three types of treatments: those used to correct angular damage and that imply a use of around three to four months. The second treatment is for differences in length, which are the elongations, where 30 to 40 days are expected for each centimeter that needs to be lengthened. This means that if the elongation goal is 5 cm, the external fixator will be used for a total of seven months.
The third method used is called the Lizarov methods, which also uses an external fixator, but in a circular shape. This method is used for severe corrections, sometimes progressive, for length discrepancies and, in particular, deformities that require progressive and slow correction. The time of use is approximately between six and eight months.

In general, the patients with external fixators can perform all their regular activities, from going to school - safely, with a protection for the apparatus - but are very incorporated into daily activities; with this assistance the patient reduces the time of disability.
Some patients might require two or three elongations during their stay at the hospital, sometimes before skeletal maturity, sometimes after skeletal maturity. “The idea is to use these methods as a reconstruction and avoid amputation procedures,” says Dr. Velázquez.

These methods apply to patients who have the cognicity to accept treatment more easily, this occurs after skeletal maturity, however, there are finals who have a final discrepancy of up to 18 cm, which requires an earlier start.
The incidence of complication in children under 10 years of age is higher, given they are not cognitively prepared for the treatment process that can be quite long. That is why it is preferred that treatment begin when the patient is older, either in pre-adolescence or adolescence.

Is it painful?

“It can be a bit annoying, but lengthening as such does not generate pain in itself, since the actual expansion per day is less than 1 millimeter, and this prepares the rest of the tissued, muscles, tendons, blood vessels, etc., which grow in parallel with the bone. But, the device is external and is connected to the bond, and this can cause inflammatory processes after some time, which can make them quite annoying,” says Dr. Daniela Velázquez.

Special Care

- Do not have contact with soil, or animals, whether companion or field animals.
- Good nutrition.
- Take sun baths, as it improves vitamin D absorption and, therefore, metabolism.
- Continue rehabilitation activities and avoid gaining weight.
- Do not be involved in high impact sports activities during treatment.
- Pulling, carrying or pushing heavy objects, or practicing high impact exercises is not recommended until a year after removing the external fixator.

Quality of life

All of these procedures have changed the expectation of treatment for patients previously thought to need a limb amputation. These procedures have changed how these deformities are treated, allowing the patient to keep their limps in good condition, and improving patients’ quality of life. This gives patients the possibility of being integrated with school activities, sports, and in the future, the labor market. Currently, there is a tendency to think of limb reconstruction instead of amputation.

The Family and the Patient as Part of the Treatment’s Success

The family’s participation is of utmost importance for the treatment to have the success expected. At Shriners Hospital, both the patient and their families are trained to handle the external fixator,perform rehabilitation and self-care exercises, handle bandages and detect signs of alarm such as infections.