There are several techniques for limb lengthening surgery, each with its advantages, disadvantages, and specific applications. Here are the main types of limb lengthening techniques:
- External Fixation:
- Ilizarov Method: Named after the Russian orthopedic surgeon Dr. Gavriil Ilizarov, this technique involves the use of an external fixation device consisting of metal rings or frames attached to the bone with wires or pins. The rings or frames are connected by adjustable rods or struts, allowing for precise control over the distraction process.
- Orthofix Method: Similar to the Ilizarov method, the Orthofix method uses an external fixation device with rings or frames connected by adjustable rods. However, the Orthofix system features preassembled modular components, which may offer advantages in terms of ease of assembly and adjustability.
- Taylor Spatial Frame (TSF): The TSF is a circular external fixation device that incorporates computer software to calculate and control the desired correction or lengthening parameters. It allows for fine adjustments in multiple planes, making it suitable for complex deformities or lengthening procedures.
- Limb Reconstruction System (LRS): The LRS is another external fixation device commonly used for limb lengthening and deformity correction. It features telescopic rods connected by clamps and hinges, allowing for controlled distraction and correction of bone deformities.
- Internal Fixation:
- Intramedullary Lengthening Nail (Precice Nail): This technique involves the insertion of an intramedullary nail into the bone marrow canal, which is then lengthened using a remote-controlled magnetic mechanism. The Precice Nail is adjustable and allows for gradual lengthening without the need for external devices.
- Plate Fixation: In some cases, limb lengthening may be achieved using traditional plate and screw fixation techniques. Plates are attached to the bone segments on either side of the osteotomy site, and gradual distraction is achieved by separating the plates over time.
- Combination Techniques:
- Hybrid Fixation: Hybrid fixation combines external and internal fixation techniques to achieve optimal stability and control over the lengthening process. For example, an external fixator may be used initially for distraction, followed by the insertion of an intramedullary nail for additional support and consolidation.
- Bone Transport:
- Masquelet Technique: This technique involves creating a temporary spacer made of bone cement or other materials at the osteotomy site. The spacer is gradually removed as new bone forms, allowing for controlled bone transport and lengthening.
- Callus Distraction: Callus distraction involves gradually pulling apart the bone ends to stimulate the formation of a new bone callus in the gap. This technique is often used in conjunction with external or internal fixation devices.
Each limb lengthening technique has its indications, advantages, and limitations, and the choice of technique depends on factors such as the patient’s age, medical history, the extent of the limb length discrepancy, bone quality, and surgeon preference. Orthopedic surgeons specializing in limb lengthening and reconstruction carefully evaluate each patient’s unique circumstances to determine the most appropriate technique for achieving the desired outcomes.
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