Overview

Gradual Deformity Correction with internal fixation is used to reposition the bones in normal alignment to improve or gain function. This surgery is often performed on bones such as the Femur, Tibia, Humerus, and Radius/Ulna. The corrections are performed over several weeks or months and may involve 1-2 surgical procedures to apply and remove an internal device. Your surgical plan will include a Distraction Phase, during which the bones will gradually be separated and aligned, as well as a Consolidation Phase, wherein the new bone starts to hardens and solidifies and finally a Healing phase, in which the bone becomes strong enough for the external fixator to be removed. With advanced technology offered at CLLC, gradual deformity correction is less invasive and more comfortable than ever before.

Indications / Candidacy

Gradual Deformity Correction is offered to patients who have had deformity since birth or early childhood, or who have developed the condition as a result of an accident or injury. At CLLC we perform gradual deformity correction for both children and adults. Candidates will be assessed by one of our surgical specialists to ensure a proper diagnosis and that all physical criteria are met before surgery.

Good Candidates for this surgery may experience:

  • Simple or Complex Deformity of the limb (in one or more planes)
  • Length difference between two limbs
  • Combination of deformity and length difference

Treated Conditions

The Canadian Limb Lengthening Center offers treatment of many complex orthopedic conditions. We pride ourselves in providing highly specialized expert care and the most up to date equipment and technologies. Using a holistic approach to acute deformity correction, we help patients treat many of the following conditions:

Condition

Acquired Deformity

Condition

Congenital limb deficiency

Condition

Genu valgum

Condition

Genu varum

Condition

Mal-union

Condition

Other Deformity and LLD

Condition

Skeletal dysplasias

Surgical Technique

Gradual deformity correction with PRECICE NAIL

Incisions for internal fixator PRECICE nail
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Deformity correction with internal fixation is often carried out at the same time as limb lengthening surgery in cases where there is an underlying deformity along with a limb length discrepancy. The technique used to re-align the bone is the same as the one used for acute deformity correction (fixator assisted nailing). A simple external fixator is placed in the bone and will be used to assist in re-aligning the bone. The bone is cut through a small skin incision to create two segments. A small incision helps to preserve all the soft tissues around the bone and leaves patients with less scaring.

An intraoperative radiograph is then taken to ensure adequate alignment of the bone and then the PRECICE lengthening nail is inserted to hold this alignment. The PRECICE lengthening nail is a telescopic nail that relies on magnetic interaction between the nail and the external remote controller (ERC) magnet to lengthen. The nail is placed in the bone and locked with bolts on either end, and the external fixator can then be removed . The acute deformity correction is complete and the lengthening will now take place gradually using the internal PRECICE nail.

PRECICE nail insertion for limb lengthening
1:53

Seven to ten days following surgery, the bone is distracted by placing the magnet (ERC) on the skin which then activates the nail to lengthen. Lengthening is done at approximately 0.75-1mm per day until the desired length is achieved. Once the length is achieved the consolidation phase starts and the bone heals around the nail.

The PRECICE ERC is programmed in order to accurately lengthen the femur or tibia based upon the surgeon’s prescription. Weekly or every two weeks, clinical and radiographic evaluations are performed to assess how the lengthening is going and the quality of the bone regeneration. The rate of lengthening may be modified by the surgeon to match the quality of the new bone formation.  The nail can also be used to compress the bone, if required clinically and programmed by the treating physician.

Results

With increased function (better walking/gait) and improved muscle strength our patients typically live very active, healthy lives after gradual deformity correction with internal fixation. For some patients, deformity correction with internal fixation can decrease pain and discomfort while providing the psychological benefits of having a more positive body image and body function. Once a full recovery has been made, patients can enjoy the same activities that they did prior to surgery. Sometimes surgery is used to avoid potential joint and spine problems in the future. Patients who were experiencing pain because of limb discrepancies and/or deformities find their symptoms improve or are completely alleviated after limb lengthening.

Potential Complications

As with any surgical procedure, Gradual Deformity Correction can have difficulties and complications. While educating patients on these potential risks, we take extensive measures to avoid complications and teach patients how to properly care for their body after surgery. In the case that difficulties arise, we have experienced specialist who know how to respond. Complications and side effects may include:

  • Delayed union, non-union or malunion of the bone
  • Superficial (skin and soft tissues) or deep infection (bone infection)
  • Neurovascular injury (very rare)
  • Compartment syndrome (very rare)
  • Joint contractures due to lengthening (hip, knee and ankle)
  • Infection of bone (osteomyelitis)
  • Fat embolism syndrome or Pulmonary embolism (very rare)

Pre-Operative Care

  • An extensive medical history will be taken during your initial assessments
  • It is recommended that you stay active and eat a healthy diet prior to any operation
  • Certain medications and vitamins may need to be stopped several weeks before
  • Discuss all medications and over the counter drugs with your surgeon
  • Use a calendar or agenda to organize your pre and post appointment dates
  • Make arrangements for personal care givers

Post-Operative Care

  • Immediately after surgery, patients are allowed to partially weight bear on the operated leg(s).
  • Patients can expect to be hospitalized for 24-48hrs after the surgery
  • The dressings are changed in the hospital on post-operative day 1 or 2 and then kept until the first clinic visit.
  • Patients are not permitted to get their dressings wet or shower prior to their first follow up visit
  • Seven to ten days after surgery, the lengthening will begin by using the ERC portable magnet that will be programmed your surgical team for the appropriate lengthening rate.
  • The patient (or care giver) will be given a schedule that instructs them how often to use the ERC magnet

Patients who will undergo this procedure should read:
Immediate post-operative care
ERC magnet instructions for lengthening

Follow-ups after surgery

  • Patients will be required to attend all post-operative appointments
  • The first follow up visit will be 7-10 days after surgery to check the incisions and remove the dressings.
  • Follow ups will then be bi-monthly with radiographs until the lengthening phase is complete.
  • Once lengthening is complete, follow-up will be monthly until complete bone consolidation is shown on radiographs.
  • Physiotherapy session will focus on mobilisations of the joint proximal and distal to the osteotomy must begin immediately
  • Full weight bearing can only begin when instructed by your surgical team. In case of external fixation correction, most times full weight bearing is permitted, but needs to be confirmed by our surgical team.

Case studies

34 year old lady with left femur valgus and LLD of the left leg

AM I A CANDIDATE?

Are you experiencing an orthopedic condition and would like to improve your physical capabilities?

Or you simply would like to achieve your long-lasting dream of improving your height?

Let us help you achieve your optimal health and wellness in a professional setting.

Let’s open up a discussion to help you achieve your goals.

Highly specialized expert care at CLLC

At the Canadian Limb Lengthening Centre we offer complex deformity correction and limb lengthening surgeries performed by experienced surgeons with the most up to date technologies. When it comes to your care, and treatment of deformity and limb length discrepancy, our surgeons have extensive training and experience.

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