Limb Lengthening

Limb lengthening is possible and has been performed successfully for about 50 years in Kurgan, Russia. Gavriil A. Ilizarov developed the concept in 1951 after seeing many WWII veterans who had leg fractures that had not healed (non-unions).

Ilizarov first developed an external fixation frame that was placed around the leg. Knowing that compression of the fracture would help stimulate bone healing, he built a frame that had this capacity. He instructed a patient to gradually compress the non-union by turning a rod. However, the patient turned the rod the wrong way and caused distraction (separation) of the fracture. Ilizarov noticed that new bone had formed in the gap between the bone ends. This was the beginning of much research and development that showed that limb lengthening was possible, safe and effective.

Ilizarov and his colleagues performed thousands of limb lengthening procedures in Kurgan, Russia. Russian politics, however, made education and communication with the Western world very difficult. Finally, Italian surgeons started performing and improving the procedure in the early 1980s and a large center soon developed in Lecco, Italy. 

The regenerated bone is normal and does not wear out. The muscles, nerves and blood vessels grow in response to the slow stretch like they do during a growth spurt or in pregnancy. The actual procedure is minimally invasive and requires only one or two nights in the hospital. Patients aren't in much pain since the distraction is so gradual and patients can continue to walk during the treatment.

Children and adults can be appropriate candidates for the procedure. Children with congenital deformities such as fibular hemimelia, congenital short femur and hemiatrophy will often have unequal leg length and this may be associated with deformity. Many adults have had this condition since childhood and have developed back pain and hip arthritis from the leg length discrepancy. Growth plate fractures and bone infections in children can cause stunting of growth that results in discrepancy.

Following trauma, bones can heal in a shortened and deformed position (mal-union). Sometimes the bone can even remain unhealed (non-union). Limb lengthening procedures address all of these issues. We have been able to successfully correct large deformities and equalize limbs with discrepancies of several inches. A segment of bone can be missing after a bone tumor, bone infection or severe fracture. We can transport new bone to fill in this defect.

Short stature can be very disabling in patients with dwarfism, for example. We can lengthen both legs simultaneously to increase stature.

Young adult patients with leg deformities are at risk for developing arthritis as a result of their malalignment. These same techniques can be used to correct severe deformities safely and avert the need for joint replacement.

These procedures can be performed with ilizarov frames, monolateral frames or more recently, with lengthening nails such as the PRECICE STRYDE nail.

precice nail

Mr Jamal regularly performs corrections of lower limb deformity, non union surgery and limb lengthening. He is a keen proponent of ankle distraction arthroplasty for ankle arthritis. He uses a variety of devices to aid optimal outcomes. These include lengthening nails such as the PRECICE nail as well as ilizarov frames

publications

He has published several peer-reviewed publications. He presents regularly at national and international orthopaedic surgery conferences. In addition to being a member of faculty on numerous orthopaedic courses, Bilal is course director of the flagship Royal College of Physicians and Surgeons of Glasgow annual international trauma and orthopaedic meeting.