A weekly column prepared by Dr. Balwant Singh’s Hospital Inc.
By Dr Suhel Kotwal, MBBS, MS (Orth)
A variety of conditions can render the limbs of an individual unequal. This can not only cause an embarrassing limp but also deprive the person of a normal day’s work or recreation. Such a person not only feels insufficient physically but also develops a psychological affliction. Limb shortening affects as much as 10% of the human population. Some of the reasons for a shortened limb can be listed briefly as follows:
– Poliomyelitis or cerebral palsy
– Injuries during childhood affecting normal bone growth
– Fractures during any stage of life
– Birth defects
– Bone tumours
– Bone infections
– Spinal conditions like scoliosis
– Dwarfism
Can a leg in an adult be lengthened?
The ability of chameleons to regrow appendages and limbs has spurred scientists to try to grow and lengthen limbs in man. Surgeons have been fascinated with the concept of limb lengthening for decades (Italians attempted it in 1905 for the first time) but had mixed results. It was a general medical practitioner from the Russian village of Kurgan who revolutionized the procedure using cycle spokes during the treatment of World War II victims. He was Gavriil Ilizarov, the inventor of the Ilizarov Ring Fixator.
H is contributions now allow lengthening of a short limb by 2 to 10 inches in one stage, and also permit lengthening of limbs to increase height in dwarfs. The use of internal and external devices and a clear insight into the biology of regeneration of tissues has made limb lengthening a reliable and safe surgical procedure.
The principle of this procedure is that if the bones of the leg are artificially broken and gradually separated with the help of a ring shaped device, the bones including the blood vessels and nerves regenerate. This separation of the bones (called distraction) has to be done very slowly at the rate of 1mm/day until the desired length is achieved. Once that is done, the device can be dismantled and person allowed to walk without any support.
What may sound ridiculously easy is in fact a very technical and highly specialized surgery to be performed only by an experienced surgeon. The consequences of a poor and amateurishly performed procedure can leave the patient with a worse disability than what he started off with.
Some points to remember before opting
for surgical limb lengthening
Before a person opts for this surgery it is worthwhile to delve into its drawbacks as well. The reasons this surgery is not for everyone is because of certain sacrifices the patient would have to make to gain a few inches of length in his legs, and it is of paramount importance that such patients comprehensively discuss the pros and the cons of this procedure with the surgeon. Some of the drawbacks are as follows:
Pain: When a normal bone is artificially broken and distracted, it causes pain of varied intensity in different individuals. Although the majority of patients don’t encounter too much post-operative pain, some of the unlucky ones may feel a nagging discomfort throughout the entire lengthening process.
Appearance: The Ilizarov Ring Fixator is an external device, lying outside the body and hence it’s not easy to hide with garments. This may affect the social life and appearance of a self-conscious person for a few months.
Delayed healing: It can’t be denied that every individual’s limbs may not lengthen exactly at the rate predicted. The healing capacity of bones, and for that matter any tissue of the body is different depending upon the general condition of that person, pre-existing medical conditions, smoking and drinking habits, etc.
Pin infection: The points where the ring device is attached to the body has to be taken care of by the surgeon and the patient alike regarding cleaning. If they are not cleaned on a daily basis, this can result in unprecedented delays in healing.
Joint stiffness: while wearing the device, if care is not taken to perform physical therapy exercises, it can result in stiffness in the neighbouring joints.
Psychological distress due to the length of the treatment schedule.
Can dwarfs also be made taller?
An interesting application of limb lengthening is the ability to lengthen both lower limbs and increase the height. This has the most logical application in childhood dwarfism. Achondroplasia is the commonest form of such dwarfism where boys are expected to grow only to 4’ 1” and girls to about 3’11”. Typically they have a normal trunk structure but their limbs are abnormally short. While most dwarfs are intelligent and well adjusted, they do tend to suffer from the social consequences of dwarfism, like climbing into a car or a bus, hitting a light switch, reaching the gas pedal of a car and a million other activities which we as normal people take for granted. It may thus become a real disability for them.
It is important to note that such patients need to devote at least a year of their lives to this treatment as it is technically difficult to perform and carry through till the end.
Elective limb lengthening is not for everyone. Most surgeries are done for reconstruction – that is, equalization of leg length and the correction of deformities. It is not a cosmetic nip and tuck procedure, and the patients who do this are not people who think, “Oh, wow, it would be really cool to be 3 inches taller.” It’s for people in severe psychological distress over their short stature or inability to walk normally. This is a complex procedure and not as simple as a nose job.
Only a person who is utterly distressed by his physical disability will truly appreciate the benefits of this difficult but almost miraculous procedure. Such a person will cheerfully barter a few months of discomfort and expenses in return for an improved quality of life. Hence, it is crucial to counsel a person thoroughly before undertaking this operation. In many centres it is compulsory to do a pre-operative psychological assessment before a patient treatment. Diligence until the end of treatment is rewarded with good results. Follow-up is crucial for the best results.
