Once a patient overcomes a chronic infection or severe injury, they can actually be left with legs of different lengths. Known as leg length discrepancy, this condition requires an orthopaedic surgeon with a unique breadth of experience.
At the Florida Hospital Orthopaedic Institute Fracture Care Center (FCC), our surgeons and medical staff possess the unique knowledge and skill to repair and treat leg length discrepancy. They’ve even experienced great success in performing these procedures cosmetically, such as for patients with shorter legs or two normal limbs of different sizes. Certain medical concerns may not involve a significant leg length discrepancy, such as premature puberty, constitutional low stature, or even achondroplasia (dwarfism). In these cases, cosmetic limb lengthening surgery may be considered as stature enhancement to increase height and for other functional indications.
Our physicains employ a process called limb lengthening (or “distraction osteogenesis”). To begin this treatment, the surgeon will surgically split the bone in two and insert the limb lengthening device. Essentially, this surgical procedure pulls the uneven bones apart at a very slow rate. This enables new bone to gradually grow and heal until an equal length is achieved. The procedure also increases the surrounding soft tissue’s volume.
One Global Journey, Dramatic Surgical Benefits
Previously, limb lengthening procedures required awkward external devices, such as pins and frames. However, in the early 1990’s, J. Dean Cole, MD, a pioneer in orthopaedic trauma surgery -- and the FCC’s Medical Director – was responsible for groundbreaking changes. Dr. Cole traveled to Russia to meet with Gavril Ilizarov, MD, an orthopaedic surgeon and the developer of this procedure’s conventional external fixators and practices. Ilizarov taught Dr. Cole the procedure’s principles.
Upon his return to America, Dr. Cole began performing the limb lengthening surgery. However, he knew a more effective treatment option was possible. Over the next 20 years, he continually perfected the process, seeking to design an internal device to obtain a predictable bone length. In 2001, Dr. Cole achieved his goal, inventing the only FDA-approved, completely internal device to lengthen limbs.
The ISKD Device; a Revolution in Bone Lengthening
Dr. Cole revolutionized limb lengthening by inventing the Intramedullary Skeletal Kinetic Distractor (ISKD), this device relies on an internal process for lengthening to increase height naturally. The ISKD technique involves surgeons implanting a telescoping rod into a patient’s bone. This rod is gradually extended through a long-term, regular program of physical movements; specifically, knee and/or ankle rotations.
As a result, these shortened bones are gradually extended until equal limb lengths are achieved. In addition, stability and alignment are increased. As the bone grows, a level of control is provided by a handheld magnetic sensor, which monitors the growth on a daily basis.
These movements are actually very safe for patients. Before any limb lengthening surgery is planned, Dr. Cole and his Fracture Care Team determine the personalized, fully extended lengthening goals for each patient. The lengthening device is then preset to that planned length.
Unlike procedures requiring external fixation pins or wires, the ISKD is completely internal. As such, the potential risks for infections and scarring are dramatically reduced. As of now, Dr. Cole and his surgical colleagues have performed this procedure on more than 100 patients. And, Dr. Cole’s ISKD is now utilized by trained orthopaedic surgeons throughout the United States and Europe.
You’ll find a more in-depth discussion of this procedure’s benefits and expected outcomes on the treatment page, as well a real-life limb lengthening case study. If you think you may be a candidate for limb lengthening in Orlando, or beyond, schedule an appointment at the Fracture Care Center. Contact us online.
For patients with uneven limbs, or “leg length discrepancies,” limb lengthening is an option. However, orthopaedic surgeons possessing unique experience are required to properly treat this condition, whether due to injury or infection.
J. Dean Cole, MD, the Medical Director at the Florida Hospital Orthopaedic Institute Fracture Care Center (FCC), has the experience and skill to address this condition. Dr. Cole is a pioneer within the field of orthopaedic traumatology. He is the creator of the Intramedullary Skeletal Kinetic Distractor (ISKD). This device, which is the leading treatment option for this condition, is one of the FCC’s hallmarks. The ISKD has proven so popular and effective that it’s now the preferred procedure for limb lengthening worldwide.
ISKD, A Transformation in Limb Lengthening
Certain factors affect the duration and success of the Intramedullary Skeletal Kinestetic Device (ISKD), including: the desired length, the speed in which bone forms, and how effectively patients follow the recommended lengthening activities. Typically, Dr. Cole and his colleagues set a goal of extending (“distracting”) the ISKD 1 millimeter (mm) each day. The process usually lasts for about one year, at which time additional ISKD devices can be implanted, if necessary.
Of course, not all patients qualify, and there is a strict selection process. Accepted candidates may have shorter limbs due to deformities or trauma; they may be seeking cosmetic limb lengthening, as well. Patients may also suffer with back pain from shortened limb lengths. Regardless, candidates should be ready to commit to the process, and thoroughly understand this technique and its limitations.
Before any procedure is considered, Dr. Cole and his colleagues determine the specific lengthening goals. They utilize preliminary X-rays, and take measurements of joint motion and body structure. These methods enable the lengthening device to be preset to the optimal planned length, ensuring a successful healing process.
Performed under anesthesia, the ISKD procedure usually takes about two hours. An orthopaedic surgeon implants a telescoping metal rod into the affected bone. Upon implantation, the surgeon splits the shortened bone in two (an “osteotomy”). In the newly created space, bone growth and healing develops gradually, until equal limb length is achieved; soft tissue, including muscle and skin, develops, as well.
After surgery, the affected, uneven bones are pulled apart at a very slow rate, until the new bones can support the patient’s weight. The gradual movement is accomplished by regular limb movements. This entire process is internal (“closed”), with no external fixation pins or wires. Once the desired bone growth is achieved, patients can have the ISKD device surgically removed.
Monitoring the Growth Process
To ensure and maintain patients’ rates of new bone growth, long-term, personalized programs of physical movements are prescribed. These movements, typically foot, knee, ankle, or leg rotations, force the telescoping rods to gradually extend new bones. Patients should take measurements at least five times each day. But this growth can be monitored at any time, especially following physical activity.
This exertion, which often involves the participation of others, may include normal activities, controlled movements and partial weight-bearing exercises. Once the Intramedullary Skeletal Kinestetic Device is implanted, it’s crucial that patients strictly follow their specific program schedules. These movements are actually very safe, and following surgery, patients receive handheld magnetic sensors. Aside from monitoring daily bone growth, these sensors greatly reduce the risk of accidentally over-stretching the newly formed bones.
The Benefits of ISKD
As the ISKD device works completely internally, with no external fixation pins or wires, potential infection and scarring risks are dramatically reduced when compared with the external device traditionally used. This procedure jumpstarts the volume of the surrounding soft tissue, and boosts both stability and alignment.
Dr. Cole and his surgical colleagues have implanted the ISKD device in more than 100 patients. The benefits of ISKD implantation have proven so successful that this procedure is now performed by trained orthopaedic surgeons throughout the United States and Europe.
Cosmetic Limb Lengthening
Limb lengthening procedures may impart valuable benefits for patients with cosmetic concerns. For instance, individuals with shorter legs may want to get taller, while others may have two legs with different lengths. Others may suffer from premature puberty. For these cases, cosmetic limb lengthening surgery may be considered as stature enhancement for functional indications.
Dr. Cole has experienced great success in limb lengthening surgery for all patients, whether due to medical or cosmetic concerns. Dr. Cole’s own invention, the Intramedullary Skeletal Kinetic Distractor (ISKD), is particularly effective for cosmetic procedures. As the procedure is internal, patients can use wheelchairs, walkers or crutches during lengthening, without the need for lengthy explanations. And unlike external fixators, the ISKD leaves patients with minimal, discrete scarring that fades over time.
At the Fracture Care Center, the typical cosmetic leg length discrepancy treatment is finalized within 45 days. The healing periods usually take 2-3 months, and most patients can return to their normal level of activities within six months. Patients are required to perform regular stretching exercises prior, during and after lengthening.
As with other surgical procedures, not all prospective patients will qualify for cosmetic limb lengthening. All age groups can undergo these procedures, once normal growth is complete. Typically, patients must be 15 years or older; these age groups also tend to have a better understanding of the procedure.
Surgeons and medical professionals emphasize that cosmetic lengthening is only for stature enhancement. As such, those with body dysmorphic disorder should not have cosmetic lengthening, as additional lengthening (or shortening) surgeries may be requested.
Lengthening does not occur automatically, so patients considering cosmetic limb lengthening must have clear goals. This is a lengthy process, requiring investments of money, time and effort. Therefore, they must be thoroughly educated about the involved surgical techniques and mechanisms. Patients must also be aware of the potential risks and complications before undergoing surgery.
It’s also important to note that insurance companies do not cover the cost of cosmetic procedures, such as limb lengthening. Therefore, patients must cover the total cost of the.
Today, patients requiring limb lengthening in Orlando, and beyond, turn to the Fracture Care Center, and specifically, Dr. Cole’s ground-breaking ISKD device. For information, or to schedule an appointment, contact us.