Limb Reconstruction and Leg Lengthening

Although it is a lengthy process, limb lengthening can provide skeletal stability and improve mobility, allowing you to live a more active life.

Limb lengthening is a complex procedure that can take months to complete. The surgery has two phases: distraction, which involves lengthening the bone and growing new bone; and consolidation which involves making the new bone strong and stable. The procedure uses internal (inside the body) and external (outside the body) devices to achieve the desired result.

During surgery a small incision is made in the skin so the surgeon can access the affected area. A Precice Nail is a device that is placed into the centre of the affected bone and secured with screws. The nail contains a magnet and a gear system, which is activated by an external handset that is placed on the limb. This is used to lengthen or shorten the nail. You will be shown how to use the handset, where to position it on your limb and how it works. Around a week after surgery you will normally start to lengthen the nail. The hospital team will make sure you are completely confident and comfortable operating the handset before you begin. Normally you will use the handset three times a day.As the bone is pulled apart using the nail, new bone starts to form and grow into the gap.
Limb lengthening is a slow process. You will normally have the nail in place for one and a half to two years. Each person is different but on average, bone lengthens at a rate of 1mm a day. The bone then needs time to harden (consolidate) before the nail is removed.
While the bone is lengthening it will not be able to bear weight, however, you will need to exercise it to prevent muscle stiffening and possible nerve damage. You may need regular check ups to ensure the process is going as it should. During these visits you will have X-rays to check how well the new bone is forming and to see if we need to speed up or slow down the nail lengthening.

There are a number of possible complications associated with bone lengthening:

• Infection – You will have surgical wounds where the nail and screws are inserted and also in the area where the bone has been divided. There is a risk of infection in either of these wounds. Possible symptoms include: increased pain in the area, redness or heat, swelling, discharge or pus, unpleasant smell, raised temperature. Sometimes people develop an infection in the bone around the nail. In this case the nail will need to be removed.
• Deep vein thrombosis – This is a blood clot. It is treated using medication that thins the blood.
• Joint stiffness and soft tissue tightness – You will be given exercises to keep your joints and soft tissues mobilised and supple. If the problem becomes severe you may require further surgery to release tightness.
• Failure of the bones to join – Sometimes bone does not form properly during lengthening or may take too long time to strengthen. Your consultant will talk to you about possible treatments if this occurs.
• Joint instability – There is a small risk of dislocation of the surrounding joint. Physiotherapy can be used to prevent this. If it does occur further lengthening may have to be abandoned.
• Nerve and blood vessel injury – This happens rarely, either at the time of surgery or during the subsequent lengthening of the bone. Symptoms include pain, numbness or pins and needles. If you are experiencing these symptoms we may need to slow the lengthening process or even abandon it altogether.
• Fracture – Rarely the bone can fracture when the nail is removed. Further surgery or a cast or brace might be needed if this occurs.
• Nail failure – Sometimes the nail or screws holding it in place may loosen or become faulty. You may need to have the nail replaced or treatment with an external fixator if this occurs.

The procedure can help anyone with different length of limbs irrespective of age or the cause of the problem.

Our patient-care process

• Once all of your diagnostic procedures are completed, we will be able to explain whether surgery is recommended.
• We will go through the procedures with you, covering the operation itself, the recovery process and the future prospects.
• Your orthopaedic surgeon will also explain the risks: these are small, but it is important for you to understand them.
• You can feel reassured that you will receive expert care from the start of the process, including your after-care.