Limb lengthening

Techniques for leg lengthening were originally developed for correction of limb length discrepancy and have become accepted therapy for such correction. Recently, similar surgical techniques have been modified for use in symmetric lengthening in short individuals, including those with intrinsic abnormalities of bone and cartilage growth. This new application has generated both widespread interest and controversy among health care providers, persons of short stature and their families.

Symmetric extended limb lengthening (ELL) while performed primarily for adaptive, cosmetic and psychosocial reasons, may also have benefit in preventing orthopaedic and neurological complications of the skeletal dysplasias. Nonetheless, there are no established medical indications of symmetric ELL at this time.

Research concerning the safety, long-term functional outcome and success of the procedure is presently being conducted in centres world-wide for comprehensive care of persons of short stature. Experimental protocols are being developed to assess the benefits and risks of ELL procedures.

It is generally agreed not to accept children under the age of 12 because it is essential that the patient, rather than the parents make up his or her mind as to whether or not this procedure might be worthwhile. The upper age limit of when this procedure could be done is 18-20 years because the tissues become too stiff to be stretched after that age.

It is possible to increase the height of the individual with achondroplasia or similar form of short stature, sometimes as much as 11 inches. Furthermore, during this same procedure bowing of the legs is corrected, removing the need for hip surgery (osteotomies) and the curve in the back is straightened, which can hopefully reduce the incidence of spinal compression later in life.

The process is a drawn out procedure which will restrict the patient to firstly wheelchair mobility (3-4 weeks) and then walking with the attachment of a rod device and pins (1-2 years). The age of the child is best when they can practically and socially go through a long stage of wheelchair confinement with home and educational life under little threat. In Australia, the cost ($30,000) would be met by Medicare.

For the person of short stature, or for families considering limb lengthening for their child of short stature, there is no easy decision about whether or not to and when to proceed with the surgery. Proceedings and information on this topic are rapidly being updated and an up-to-the-minute consultation is required.

Numerous possible complications of ELL techniques are recognised, including nerve injury, infections, angulations, non union, paralysis, increased hip flexion leading to dislocation of the hip, predispositions of early osteo-arthritis, re-absorption of bone ends, fractures and unequal limb lengths. Although the acute complication rate associated with ELL has been reduced, it is still substantial. Furthermore the long-term stability of extended limbs, particularly when subjected to physical or hormonal stress (including for example in pregnancy) or their long-term effects on the spine and pelvis are being evaluated but are not yet known.

(Source: Information Guide to Persons of Short Stature, edited by Stephen Pinnell, p. 23)

© 2014 SSPA.