Techniques for lengthening

Prof Dr Khaled EmaraAin Shams University

Cairo, Egypt

UPPER END

LOWER END

SHAFT

The lengthening site The first step in lengthening is we the

-Orthopaedic surgeon- make a surgical cut in the bone by a special technique

This cut act as a growth center for the bone

The direction of growth & stability of the bone till we finish lengthening is controlled by several fixation devices & techniques

osteotomy site

Internal & external fixation

Techniques of fixation & lengthening Pure external fixation (old classic ) External fixation for lengthening

over a nail External fixation & lengthening then

early removal & replacement by a nail once lengthening is finished

Internal lengthening nails with out external fixation

External fixation It is an old technique have been used

for a very long time It is effective & safe But it is uncomfortable for the patient

as the external fixation stay for a long time in the leg (about one month for every centimeter lengthening)

Need close follow-up & care by the patient & the doctor

Frame

Gradual:

uniplanar VS. circular X FX

Risk of infection at the pins of the external fixation or soft tissue irritation is the most common problem (usually a minor problem) controlled by frequent cleaning & antibiotics

The patient discomfort due to the bulky device which can limit the activities during lengthening

Need regular cleaning of the pins & physical therapy for the muscles & soft tissues

It give better control over the lengthening & soft tissues as the muscles & nerves

Internal lengthening devices More comfortable fro the patient as the

lengthening device is inside the bone not out side the leg

But less control on the device as it can go faster or slower than required for lengthening, this can cause new bone callus problems as premature healing of the lengthening center in the bone before finishing lengthening

Also it can cause too rapid lengthening with much stress on the muscles & joints & nerves & this can be harmful to the function after lengthening

Nail jamming or mechanical problems that can happen during lengthening

The control over that device is not as good as the external fixation device

More expensive

Lengthening over nail

This can be used to put a nail inside the bone & lengthen the bone by external fixation device till finish lengthening then we remove the external fixation & fix the nail finally at the new bone length so we don’t need to keep the external fixation device till full maturation of the new bone

This technique give shorter duration of external fixation (1/3 the pure external fixation technique)

This give more comfort to the patient & earlier rehabilitation & regain of muscle power & joint range of movement

There is higher risk of deep bone infection than other techniques

Lengthening then nailing Remove the external fixation device

once we finish lengthening & replace by a nail at the new length

This technique has the same advantage of lengthening over nail but with much less risk of infection & more patient comfort

We recommend this technique as it is safe & effective

Thanks Dr Khaled Emara 13 B Kornesh EL Nile, Agha Khan, Cairo,

Egypt Tel: (202) 2055661, (202) 2055664 Tel: (2012) 2513929 Fax: (202) 2055662 Email: kmemara@hotmail.com Web site: www.khaledemara.com