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Leg lengthening--shortening Description:
BONE LENGTHENING
Lengthening an abnormally short leg may be recommended for children whose bones are still growing (skeletally immature). This is a series of treatments involving several surgical procedures, a lengthy convalescent period, considerable risks, but can add up to 6 inches in length.
While the child is deep asleep and pain-free (using general anesthesia), the surgeons carefully study the blood vessels and blood supply to the bone. An incision is made in the bone to be lengthened; usually the lower leg bone (tibia) or upper leg bone (femur). Metal pins or screws are inserted into and through the skin and bone above and below the bone incision and the skin incision is stitched closed. A metal device (such as an Iliazarov device) is attached to the screws in the bone and will be used later to gradually
Indications:
Surgical treatment may be recommended for severe unequal leg lengths caused by: - poliomyelitis and cerebral palsy
- small, weak (atrophied) muscles or short, tight (spastic) muscles may cause deformities and prevent normal leg growth
- hip diseases such as Legg-Perthes disease
- previous injuries or bone fractures that may stimulate excessive bone growth
- abnormal spinal curvatures ( scoliosis )
- birth defects (congenital deformities) of bones, joints, muscles, tendons, or ligaments
What to Expect After:
Epiphysiodesis is usually successful when performed at the correct time in the growth period, though it may cause an undesirable short stature .
Bone(femoral) shortening may achieve more precise correction than epiphysiodesis, but requires much longer convalescence.
Bone (femoral) lengthening is completely successful only 40% of the time and has a much higher rate of complications.
Convalescence:
With epiphysiodesis (epiphyseal arrest), hospitalization up to a week is common. Occasionally a cast is placed on the leg for 3 to 4 weeks. Healing is complete in 8 to 12 weeks, at which time full activities can be resumed.
With bone (femoral) shortening, 2 to 3 weeks of hospitalization with bedrest is usual. Occasionally a cast is placed on the leg for 3 to 4 weeks. Muscle weakness is common and muscle-strengthening exercises are started soon after surgery. Crutches are used for 6 to 8 weeks. Some children require 6 to 12 months to regain normal knee control and function. The intramedullary rod is removed at 1 year.
With bone (femoral) lengthening, hospitalization lasts a week or longer. Intensive physical therapy is required to maintain normal range of motion. Frequent visits to the doctor are necessary to adjust the lengthening device. Meticulous care of the pins holding the device is essential to prevent infection. Healing time is determined by the amount of lengthening. For each centimeter of lengthening, 36 days of healing is required.
Risks:
Risks for any anesthesia are: Risks for any surgery are: Additional risks include: - bone infection ( osteomyelitis )
- injury to blood vessels
- poor bone healing (delayed or non-union)
Costs:
The costs of any surgery varies significantly between surgeons, medical facilities, and regions of the country. Patients who need more extensive surgery will require more intensive and expensive treatment.
Surgery charges can be separated into five parts: 1) the surgeon's fee, 2) the anesthesiologist's fee, 3) the hospital charges, which includes nursing care and the operating room, 4) the medications, and 5) additional charges.
1. Surgeon's fee: varies depending on the type of surgery
2. Anesthesiologist's fee: averages $350 to $400 per hour
3. Hospital charges: basic rate averages $1,500 to $1,800 per day
4. Medication charges: $200 to $400
5. Additional charges: assisting surgeon, treatment of complications, diagnostic procedures (such as blood or Xray exams), medical supplies, or equipment use.
Insurance coverage for surgery expenses depends on many factors and should be explored for each individual instance.
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