Limb lengthening in children: Balancing hope and risks

Limb lengthening surgery in children is a medical procedure designed to address conditions where one or more limbs are shorter than normal. This innovative technique offers hope to children and their families, but it also comes with its share of risks and considerations. In his latest online article, Mr Jean Marc Guichet delves into the intricacies of limb lengthening in kids, exploring both the procedure itself and the potential risks involved.

What is limb lengthening?

Limb lengthening is a surgical procedure aimed at increasing the length of a limb. It is commonly used to address conditions such as limb length inequality, where one limb is shorter than the other, or short stature resulting from congenital conditions, trauma, or disease.

Procedure overview:

The limb lengthening process typically involves the use of an external fixator device, which is attached to the bone through surgical incisions. This device allows controlled distraction of the bone, stimulating new bone formation at a rate of approximately 1 millimetre per day. Over several weeks to months, the bone gradually lengthens, filling in the gap created by the distraction.

During the distraction phase, patients undergo regular monitoring to ensure that the process is proceeding as planned. Once the desired length is achieved, the fixator remains in place for a period of consolidation, during which the new bone strengthens and matures. Finally, the fixator is removed in a second surgical procedure.

New techniques, stimulating bone growth, are available with internal nails, which free the patient to do sports. Independently of the discrepancy, other lesions occur (absence of knee cruciate ligaments, hip or foot deformity, and a thorough programme is required to correct all deformities during growth and allow the child to become a fully functioning adult.

Risks and complications:

While limb lengthening can be highly effective, it is not without risks. Some potential complications include:

• Infection: Surgical site infections can occur, requiring prompt treatment with antibiotics.
• Delayed or non-union: In some cases, the bone may take longer than expected to heal or may fail to unite completely, necessitating further intervention.
• Nerve or blood vessel damage: Damage to surrounding nerves or blood vessels can occur during the surgical procedure, leading to sensory or motor deficits.
• Joint stiffness: Prolonged immobilisation during the lengthening process can result in stiffness and reduced range of motion in the affected joint.
• Psychological impact: The lengthening process can be physically and emotionally demanding for children and their families, requiring patience and resilience throughout the treatment journey.

Complications are drastically decreased with the use on internal nails, without suppression all of them.

Preparation and recovery:

Prior to undergoing limb lengthening surgery, children and their families undergo thorough preoperative evaluations to assess their suitability for the procedure. This may include imaging studies, laboratory tests, and consultations with a multidisciplinary team of healthcare professionals. Some preoperative ‘conditioning’ or training might be required. A clear surgical plan needs to be set up to the end of growth for security for the child and parents

Recovery from limb lengthening surgery is a gradual process that requires dedication and commitment from both patients and caregivers. Physical therapy plays a crucial role in helping children regain strength, mobility, and function following the procedure. Additionally, ongoing monitoring and follow-up care are essential to ensure optimal outcomes and address any complications that may arise.

You can schedule an appointment with Mr Guichet on his Top Doctors profile.