Limb Lengthening surgery is a type of orthopedic surgery performed for to make an arm or leg bone longer. Aims of this surgery are to treats discrepancies (differences) in the length of an extremity or to increase total body height (cosmetic lengthening / stature lengthening).

Limb lengthening surgery can be done by surgeons on the following bones;

• The upper arm bone (humerus)
• Forearm bones (radius and ulna)
• The thigh bone (femur)
• The shin bone (tibia)

Procedure Details

This procedure involves surgically cutting the bone that needs to be lengthened and using an external or internal lengthening system to widen the space between the ends of the bone. As the device gently separates the two segments of bone, new bone material gradually forms in the created gap, solidifying over time.

Every day, a small amount of new bone is produced in the space between the lengthened bone ends. In fact, bone lengthening is a process that utilizes the body’s ability to renew itself. While the length of bone increases, also muscles, ligaments, blood vessels and nerves, as well as the surrounding supporting soft tissues stretch and adopt new length.

Differences in limb length, where one arm or leg is shorter than the other, can result in significant challenges and may give rise to additional health issues, such as pain in the back, shoulders, hips, or knees. While limb length disparities can impact both arms and hands, discrepancies in leg length are more prevalent. This condition can affect both adults and children and may be attributed to congenital or acquired factors. Many individuals with noticeable differences in limb length may find relief through surgical procedures aimed at lengthening the limb.

The majority of cases involving unequal leg length are congenital, meaning individuals are born with these conditions. However, other instances may be acquired due to traumas or infections that damage growth plates in the bones, poorly healed bone fractures, or bone tumors, all of which can impede growth and lead to one leg being shorter than the other. For instance, survivors of a polio infection commonly experience this issue.

Leg Length Discrepancy

Limb length differences, in which one arm or leg is shorter than the other, can be debilitating and lead to other medical problems, such as back, shoulder, hip or knee pain. Although limb length discrepancies can affect the arms and hands, leg length discrepancies are more common. Leg length discrepancy can be a problem for adults or children and can be caused by a congenital or acquired problems. Many patients with significant length differences will benefit from limb lengthening surgery.
Most cases of unequal leg length are congenital conditions (those people are born with). But other, acquired cases may be caused by traumas or infections that damage bone growth plates, poorly healed bone fractures, or bone tumors, all of which can affect growth and cause one leg to be shorter than the other. For example, it is a common issue among people who have survived a polio (poliovirus) infection.

How much leg length discrepancy is normal?

Differences in leg length under 10 mm generally do not cause discomfort and seldom necessitate surgical intervention. Disparities of 10 mm or more, however, can lead to bodily asymmetry, potentially resulting in discomfort in the lower back and hips, among other issues.

The legal age limit for cosmetic lengthening surgery is 18 years. Cosmetic surgery is not recommended for anyone under the age of 18. For some individuals, growth in height may persist beyond the age of 18. The completion of bone development is ascertainable through radiographic means. If limb lengthening surgery is going to be performed only for cosmetic reasons, optimal age is between 20 and 50. 

As age progresses, bone quality decreases and bone resorption increases. This means that the bone of the person who has had lengthening surgery will have difficulty in union. Generally, limb lengthening surgery is not preferred for people over 50 years old. 

In addition, people considering stature lengthening are usually asked to undergo psychological evaluation to assess their ability to make the decision to have surgery and whether they are in the mood to undergo the process. In this manner, the suitability of the decision to undergo surgery can be evaluated by bolstering the individual’s psychological well-being. 

Medical lengthening surgery can be performed at any age depending on the condition and diagnosis of the patient. An examination of the bone structure takes into account factors such as bone age of the patient, bone diameter, proportions, tendon and muscle structure, and the surgical approach is determined with the patient. 

At this juncture, it is critical to always account for potential complications that could arise from extended surgical procedures. With advancing age, the bone’s capacity to heal diminishes, extending the recovery period. In addition, existing medical conditions, smoking, and previous surgeries may adversely affect bone healing. 

Individuals who are non-smokers, have good physical and mental health and candidates without any chronic diseases or hormonal problems are preferred for surgery 

For smokers, quitting to smoke is definitely obligatory. 

External Fixators:

External fixators are placed outside of the arm or leg. Some external fixators go around the limb while others run parallel to the limb.  External apparatuses are usually removed following the consolidation phase, once the newly formed bone has attained sufficient strength to support weight.

Ilizarov (ring or circular fixator) method:

When meticulously planned, this approach can yield highly favorable outcomes, particularly for individuals with short stature or leg curvatures.   This technique is often not recommended for surgeries aimed at sosmetic limb lengthening surgeries due to the extensive array of wires and screws involved, which stay within the patient’s body for an extended duration. This can lead to potential infection risks and diminish everyday comfort. Additionally, when the device is eventually removed, it tends to leave more significant scarring compared to alternative procedures.

Unilateral (straight) fixator:

These systems are placed on one side of arm or leg rather than in a ring. although unilateral systems can improve comfort, they unfortunately do not provide perfect comfort for the patient because they are extracorporeal devices, such as circular fixators.

This method is generally applied in a selected patient group, mostly children.

Combination System (external fixation devices together with the nail)

This is a method that uses a combination of external and internal systems to improve patient comfort. One of the most important advantages of this method is the reduction of total lengthening time.

Once the lengthening process is complete, the external fixator can be removed. Moreover, due to the increased stability of these systems, patients may begin ambulating with support as early as the second day post-operation. The disadvantages of this system are that the operation takes slightly longer than with external systems and the surgical technique requires experience.

Motorized nail (Internal) system:

There is only a special motorized intramedullary nail with lengthening function inside the bone. Lengthening is done by external remote control system.

The most important advantages of this method are the very small scars compared to other methods and the increased comfort of the patient. This method is especially recommended for patients who wish to return to work as soon as possible.

Postoperative pain is similar to other methods. Given the absence of any external device, patients can navigate more freely and regain mobility quicker than with alternative methods. Furthermore, the lack of external contact with the skin minimally reduces the risk of infection compared to other approaches. The biggest drawback to these methods, which are the most desirable methods of “cosmetic” lengthening, is that magnetic nails are expensive

How do you decide which method to choose for lengthening?

In lengthening surgery, the amount and method of lengthening that minimizes risk should be chosen based on the individual’s bone thickness, bone structure and health. In determining the most suitable lengthening technique, it’s essential for patients to engage in thorough discussions with their surgeons regarding all available surgical options, their respective benefits and drawbacks, and the most appropriate method for their specific case. better for them.

What is the recovery duration following cosmetic surgery?

The period required for complete recovery from cosmetic surgery differs from person to person. Comorbid conditions, smoking, or alcohol abuse can all have adverse effects on the recovery process.

What follows limb lengthening surgery?

In the event of a successful procedure, patients typically remain in the hospital for 5 to 10 days post-surgery. Before discharge, patients receive instructions on operating their limb lengthening device.

For those with an external device, daily cleaning of pin sites is essential to prevent infections. If an internal device is used, maintaining cleanliness of surgical incisions is crucial until they heal.

Patients undergoing lengthening of a leg bone may be unable to walk for several weeks and might require a wheelchair, crutches, or other aids. Similarly, those lengthening an arm may face restrictions on lifting for a few weeks.

Physical therapy:

Consistent postoperative physiotherapy significantly influences the healing process. Physical therapy sessions, several times a week, help maximize the outcomes of limb lengthening surgery. Exercises designed to enhance muscle strength and range of motion are crucial. Physical therapists provide guidance on performing home exercises.

Regular check-ups:

X-rays are taken to monitor the progress of new bone growth. If the growth is too rapid or slow, adjustments to the treatment plan may be necessary.

What occurs after the completion of limb lengthening?

Once the desired bone length is achieved, a consolidation phase follows, lasting up to three months. During consolidation, the bone lengthening device remains in place, but no further adjustments are made. Continued adherence to physical therapy recommendations is advisable.

How long is the surgery duration?

The lengthening procedure’s duration varies based on the method employed and individual requirements. Typically lasting between 2 and 4 hours, the procedure’s duration may vary depending on factors such as the individual’s height enhancement goals, bone structure, the targeted area for lengthening, and the chosen method.

How long does the surgery take?

The length of the lengthening procedure varies based on the chosen method and the individual’s needs. Typically, the procedure lasts between 2 and 4 hours. However, this duration can fluctuate depending on the person’s goals for height enhancement, the bone structure, the specific area being lengthened, and the selected surgical approach.