Working in collaboration with local, national, and international facilities, the orthopedic medicine and surgery specialists at REOrthopaedics, Inc., in San Diego have spearheaded numerous scientific investigations that have led to practical treatment solutions bringing immediate benefits to patients and families throughout the world.

DEFORMITY CORRECTION BONE DEFORMITY & LIMB LENGTHENING

Bone Deformities and Limb Lengthening - Treatment Methods at Our Southern California Practice

At REOrthopaedics, Inc., our orthopedic surgeons have assisted thousands of patients suffering from complex bone deformities through individualized treatment plans designed to correct their musculoskeletal disorder. This includes methods of limb / bone lengthening, used to treat patients that have a measurable difference in the length of their limbs. Bone deformities can have a serious functional effect on the patient and should be treated based on the individual’s needs and goals.

Scientific Article 1: Segmental Tibial Defects: comparing conventional and Ilizarov Methodologies / CORR, 1994

Scientific Article 2: Treatment of Segmental Bone Loss Due To Infection / AAOS Monograph: Management of Limb Length Discrepancies, 2011

Patients with bone deformities looking for treatment via limb and bone lengthening or other methods are welcome to contact our Southern California practice. We are pleased to serve patients from throughout Mexico, the United States, and around the world

Bone Deformities

Bone deformities can be caused by several factors, including:

These injuries can also lead to an associated loss of the soft tissues such as skin and/or muscle.

Bone deformities can consist of a bend or twist in the bone, shift in bone position, or a difference in bone length. In many cases, an osteotomy (a cut made in the bone) is used to correct the deformity. Read below to learn more about treatment options for bone deformities, but keep in mind that our Southern California specialists cater treatment to your specific needs. A comprehensive, individualized treatment plan is ideal when treating any musculoskeletal disorder.

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Bone and Limb Lengthening

Limb lengthening is a gradual process commonly used to treat differences in bone length through new bone and soft tissue growth. Regeneration of bone and soft tissue occur as they are gently pulled apart at an approximate rate of one millimeter per day. The total amount of time required for the limb lengthening process is dependent on the length of growth needed in each individual case.

Limb lengthening consists of two phases:

  • The distraction phase: during which the limb is lengthened to its desired measurement
  • The consolidation phase: as the newly formed bone hardens and calcifies to its full strength

To protect the bone during these phases, the process of lengthening is performed using either internal or external fixation devices attached to the bony fragments. The treatment options depend on the individual deformity. To learn more about these treatment methods, read on further, below.  Patients can determine their own progress on  lengthening lower extremities by  observing the cartoon that follows.

Measuring Lengths

Tibial lengthens: when your feet are flat on the floor and together while seated and someone observes your knees from the front, discrepancies in tibial length are easily measured by marking the lower-most point of each knee cap, holding a straight-edge(level to the ground) against the two points and measuring the difference in heights (inches or millimeters).   Just be sure the thighs, knees, legs and feet are together and parallel.  To measure for femoral length: sit in a chair with your back and buttocks flush up against the back of the chair.  Then, with your knees bent at 90 degrees and your legs and feet together and pointed straight out from your body, measure the difference in how far out your knee caps project from your body (image on your right).

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Fixation Strategies and The Methods of Ilizarov

Although the orthopedic surgeons at REOrthopaedics, Inc., have experience using many different methods for limb lengthening and the repair of significant bone deformities, the external fixator designed by the Russian surgeon, Professor Gavriil Ilizarov, is the one most commonly used at our Southern California area practice.

Photo and X-ray of Ilizarov Circular Fixator in Use

The Ilizarov Method of External Fixation is gentle to the surrounding tissues and therefore, is associated with a low risk for infection. Stability is provided by a frame (seen above), situated outside the body. It is attached by pins to bone above and below the injury . The pins transfer mechanical stresses to the frame, allowing the site to heal and the patient to function during treatment. To avoid infection, the reconstruction takes place between the sets of pins and avoids the use of internal hardware.

Like any other treatment modality, the methods of Ilizarov have a near perfect success record if performed in conjunction with balanced institutional resources, a favorable clinical environment, and on a patient with an injury that lends well to this kind of treatment. For more information about treatment methods for limb and bone lengthening, contact REOrthopaedics, Inc., serving patients throughout the United States, Mexico and across the globe.

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The Treatment Methods Explained

Below, Dr. Cierny explains fixation strategies and the Ilizarov method.

The instrument most commonly used to repair significant bone deformities is an external fixator designed by the Russian surgeon, Gavriil Ilizarov. To stabilize the extremity during repair, the device attaches to the normal skeleton, on either side of the injury, with sets of small, crisscrossed wires. To repair segmental bone defects, various methods are utilized:

  • shortening the frame and limb to allow end-to-end healing.
  • bone transport: an internal, segmental lengthening (figure one).
  • compression/distraction: a combination of methods wherein the bone is simultaneously shortened and the limb lengthened, with or without an interval of bone transport.

Figure One

The Protocol

The wound is debrided (cleaned), and the limb stabilized with a transport frame. A length of bone, above or below the defect, is then prepared and fixed to the frame with wires; an osteotomy (cut through the bone) is gently performed to separate the chosen piece from the remaining bone - this piece will be the transport segment. Injury from the osteotomy will also initiate a local, reparative process in the remaining bone (the regenerate). When the frame slowly moves the transport segment toward the defect, the regenerate is placed under tension (distraction) and elongates to completely fill the distraction gap. When distraction stops at the end of transport or lengthening, the regenerate will consolidate into bone. The new, generated segment is exactly the length and size of the original, bony defect. Traversing the defect, the transport segment must correctly interface with and heal to the docking site (other side) with a solid, bony union.

Defects in bone can be due to trauma (i.e., motor vehicle accident), a birth deformity (congenital defect), a surgical excision for disease (i.e., infection) or a disease process, itself (i.e., tumors). These injuries can also lead to an associated loss of the soft tissues such as skin and/or muscle. If such a composite loss exposes the transport segment or docking site, wires can be inserted in such a way as to capture soft tissue for transport with the bone segment. An “open” transport uses distraction methods to simultaneously close a hard and soft tissue defect. Conversely, if the overlying tissues are intact, the bone and wires will simply pass through them.

Like any other treatment modality, the methods of Ilizarov have a near perfect success record if performed in conjunction with balanced institutional resources, a favorable clinical environment, and on a patient with an injury that lends well to this kind of treatment. Figure two, below, posts results of the first study to compare Ilizarov with conventional methods when managing infected non-unions of the tibia with significant bony defects. In the first treatment, the tissues were aligned, restored and allowed to heal; in the second treatment, a definitive reconstruction was performed and followed by two or more years (final outcome). For updates in our bone transport protocol and treatment outcomes, please refer to our recent publication "Limb Lengthening for Bone Loss Due To Infection" published in the 2011 AAOS Monograph: Management of Limb-Length Discrepancy.

Figure Two

The transport segment and its wires exert a slow, constant pressure on anything in their path. Soft tissues respond to this pressure in a natural way, dieing back just enough to allow the objects to pass on through. The process is gentle and constant, very similar to the way our gums will melt away to allow an adult tooth to push up into place. The bone simply pushes through and the wires and pins leave thin, linear scars to mark their passage.

REOrthopaedics, Inc. - Serving Patients throughout the United States, Mexico, and Across the Globe

For more information about the methods of Ilizarov used for limb and bone lengthening or the correction of significant bone deformities, contact our Southern California practice. We have helped patients throughout Mexico, the United States, and across the globe.

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