The search for ideal harmony throughout history has nearly always referred to things both visible and invisible. In the past, individuals underwent complete transformation through plastic surgery. Today, various corrective methodologies are gaining interest, with such interventions going under the name of cosmetic limb lengthening methods. Orvill Lee Abbet started limb lengthening methods by distraction in the 1910s.
Also, Dr. Ilizarov developed a method allowing conservative treatment options for fractures in the 1950s. Subsequently, he adapted these methods that have become popular today by officially opening the lengthening center in Kurgan in 1969. Although these procedures are not new, they are trending in the press as cosmetic orthopedics in order to change or correct the length or shape of the limbs. The reasons why individuals undergo these operations or what novel techniques and materials are used for orthopedic elongation procedures are not well defined.
A component with various antigens, the foot is an organ with multiple interlocking components, is associated with anchored ligaments, resulting in fewer dislocations and fractures and a faster calcification time. Although the femur and tibia are the most weakened parts following a compound fracture, many operations adverse effects may be solved by doing complete orthopedic treatment at the required time. Limb lengthening surgery options that consumers in general do not consider, and perfectionist ladies take this into consideration.
Any osteotomy techniques, regardless of the operation, will have particular characteristics. Many osteotomy procedures involve making small cuts in the bone – standard – so that the bone is not damaged by the black form as it prolongs its sound, corrects rotational deformity, etc. Orthopedic lengthening surgery involves long legs, femur, and tibia shortenings.
Limb lengthening techniques comparison have come a long way from their infancy. In this article, I will be giving a comprehensive guide and analysis on limb lengthening techniques comparison. I will be covering major principles, complications, and comparing new methods to the classics.
Why do we need to lengthen? Limb lengthening methods have always presented as many wanted to learn about even before they were subjected to it. People have always found being tall is beautiful, and internal vs external limb lengthening once was an aesthetic procedure men and women used just to be taller, but it has its orthopedic implications: limb lengthening can treat limb-length discrepancy resulting from causes like congenital, acquired (such as fractures, infection, poliomyelitis, Ollier’s disease), malunion, growth arrest, post-removal of femoral nail in the face of technical difficulty in the use of osteotomized site, and in cases where direct approximation of local bone grafting is required as a few centimeters are added on each side of the graft in length simultaneously avoiding problems related to instability and morbidity of the use of joint span internally lengthened bone and soft-tissue contractures which have not only functional advantage like total hip-knee replacement with simultaneous ipsilateral femoral osteotomy but also good cosmetic results.
This is a technique that was, and still is, getting popular and a technique that a lot of doctors and patients ought to learn more about. In this article, which discusses internal vs external limb lengthening and a comparative study of various techniques and their outcomes, we divide limb lengthening techniques comparison broadly into two methods – either external with a fixator unit that is in direct contact with body fluids or can cause inflammation of the skin around the pins or internal in which the implant is wholly inside the canal.
Various limb lengthening methods can be used in cosmetic leg lengthening, otherwise known as cosmetic limb lengthening surgery options. This process, through the elongation of the legs, requires an extension of the bones. One must consider the distinction of the techniques that can be fully observed from the external, as well as the application, risks, and advantages of the techniques that are applied from within the body.
In some cases, both methods may be used. In general, the following capabilities are offered by both the internal and external cosmetic limb lengthening methods as cosmetic surgical techniques. As well as the correction of existing leg length differences, these studies will investigate whether cosmetic lengthening from scratch meets the expectations of society, participants, and whether it is worth the trouble.
Primary indications for cosmetic internal vs external limb lengthening and the higher metabolism and activity profiles and attitudes it encourages in participants can be used in medical examinations that help determine the appropriate surgical indications, thereby contributing to the development of this interdisciplinary of medicine. This article will review all of the significant and applicable techniques of cosmetic leg lengthening that have been created to date.
The advantages and disadvantages, as well as the results obtained by the researchers of these techniques, will be outlined. Each person’s expectations, as well as the surgeon’s own approaches, must take these results into account. It is more desired because these methods are less invasive in techniques that are made from the skin and from outside the body as a whole, not only under the microscope, towards the methods that are made from inside the body. The techniques are classified in the following manner.
Various devices can be used in the limb lengthening surgery options from the outside of the body, which can vary in complexity from the technique used in distraction epiphyseodesis and the more modern version. In order to fully understand these techniques, the device used and their application should be discussed. When a physician chooses to remodel the bones, in order to achieve the aesthetic outcome when they are longer, he may have them widened at the same time that they are made longer. Many of the lengthening procedures are presently done by nursing professionals, utilizing methods that are rarely performed in general hospitals, unless they are cosmetic.
By definition, the internal methods of limb lengthening surgery options refer to a group of procedures and implants in which the bone segments are set inside soft tissues from the start of the treatment until the terminal follow-up. Resection of the bone, controlled osteoclasis, or corticotomy may be used to perform a diaphyseal segmental osteotomy, which allows for the correction of cosmetic deformity at the same time, followed by lengthening. The medullary space may (intramedullary nailing) or may not (intramedullary lengthening nails, mechanical axis deviation = Mediation, submuscular plating) be entered and engaged into the procedure. In some cases, lengthening may be combined with simultaneous limb axis correction according to the technique described by the Paley Orthopedic and Spine Institute. The mentioned limb lengthening techniques comparison present a substantial number of variations in terms of equipment, the lengthening mechanism, osteosynthesis methods, and bone healing during the lengthening period, while both the openly available publications of the method and the track record of individual institutions also vary.
Ex: MEDINAILS, FITBONE, LON, LATTICE. These devices do not differ fundamentally in terms of their technical design, with the main issue related to the individual implant brands and the track record of the surgical facility. Bone healing during the lengthening period is expected to be questioned primarily with this group of lengthening methods compared to non-medullary techniques. In: PRECICE, ISKD, STRYDE, NS-RED. Intra- and extramedullary version of one implant with varied technology. The main separator within the internal group of methods of cosmetic leg lengthening is subsequently identified as the intramedullary method.
The main advantages of femoral elongation by the internal limb lengthening method are low invasiveness and absence of infectious complications. The main advantages of the Ilizarov external fixation device in the femoral and tibial areas straightening are precision and low loss of angular deformities. The main disadvantages are a long rehabilitation period, high emotional burden, and the need for psychological preparation of the patient and correction of limb deformities.
When using an internal device for tibial lengthening, there is a decrease in the number and severity of these disadvantages due to the good tolerability and rapid rehabilitation of such a device. When using a nail to lengthen the tibia, greater control of bony regenerate formation is possible than in the area of femoral elongation by intramedullary nailing. In the area of femoral elongation, it is better if the bone is lengthened slowly to avoid bowing.
During the recovery period in limb lengthening surgery options, external fixation devices require careful wound care and the implementation of certain physiotherapy exercises. Among patients who have undergone lengthening using the internal lengthening device, psychological status remains stable, and postoperative care is simplified. Among those who underwent limb lengthening techniques comparison by the Ilizarov external device, a pronounced deterioration in the quality of life was noted, which makes the external fixation device unacceptable for fashion and entertainment lengthening.
Postoperative pain syndrome using an internal lengthening device is less pronounced than when using an external method. As observed in patients with unilateral limb lengthening surgery options, patient satisfaction is higher after internal lengthening. At the same time, the spectacle of a person with external devices attracts the greatest attention.
Limb lengthening is the prolongation of the femur, tibia, or humerus. After the increasing rate in the last decades, the surgical methods can be placed in different categories. The Ilizarov method’s hallmark of limb lengthening includes transosteal muscle-fiber traction that stimulates fibrogenic ensheathed osteogenesis at the cortices with extensive periosteal distraction. The modified monolateral fixator uses periosteal distraction paired through the same waveform. Intramedullary nail devices, unlike external fixators, use mechanical elongation by spinning or rotating a rod subsequently lengthening the bone.
Some types, such as the ISKD, PRECICE, Fitbone, and Albizzia limb lengthening nail, are remote-controllable with a magnetic device and motor-tech facilitating the apparatus interferences. Intramedullary devices by infinite state of bone connection are subjected to complex adverse effects of unaware bone connection breaking including device breakage, telescoping, causing too little an elongation, and nonunion. The advantages of the Ilizarov technique are low cost while PRECICE a minimum percentage of post-op healing problems.
After infection, malunion, nonunion, and refracture rates are also lower in the modification of the Ilizarov as well as the monolateral methods. There are only a few differences in the cost of applying and definite height outcomes in operated patients between the two. The rod methods usually provide less post-operative pain lingually with great lengthening height outcomes comparatively.
One of the most crucial aspects of the entire process is the issue of pain intensity and the method of its suppression. The pain management scheme is significantly different from that in the case of simple surgeries. Usually, strong opioids, such as piritramide 7.5–15 mg every 3–4–6 h intravenously, were administered in the early postoperative phase, and metamizole 2 g intravenously was administered before wound manipulation.
Intravenous paracetamol 1 g every 6 h, against a background of pregabalin 150 mg and gabapentin 2 × 900–1500 mg per day and ketamine (1 mg/kg single dose, followed by a continuous intravenous infusion of 15 mg/h for 36 h) was given. Later, at the patients’ request, the metamizole was replaced with indomethacine-like non-steroidal anti-inflammatory drugs. In addition, slow-release morphine 10–20 mg once daily was given orally in the evening as an augmentation. A pain pump was installed for ambulatory patients.
Effective pain management will increase the patient’s comfort and enhance their physical (courage) and psychological (good relations with medical staff) well-being. Since very strong opioids are administered, temporary sedation may last for a few minutes or slightly longer. It usually does not affect the perception of pain from the initial wound closure, which might last for a few minutes. It is essential to start limb rehabilitation soon after the surgery.
Acceptable analgesia is necessary since rehabilitation starts from the first postoperative day. For this reason, drugs with a long half-life may be used, such as morphine and gabapentin or pregabalin. Anticoagulants are administered for venous thromboembolism prophylaxis until the fixator is removed (in the absence of other contraindications such as heavy blood loss).
Height increase obtained with limb lengthening is influenced by various factors. These factors include genetic, constitutional, and surgical factors. When considering these factors, it is important to take into account the patient’s motivations, unconscious abuse, nutrition problems, and bone quality. There are three main principles that should be understood better than others: the physiological and constitutive properties of the limb bones being lengthened, the surgical techniques to be used, and the technical capabilities of our workshop.
There was a strong relationship between the initial length of the bone and the height increase achieved through total lengthening in the lower leg. However, there was no significant relationship between the height increase and the lengthening in the forearm. Models showed a difference of a few millimeters in the relationship between bone length-age and height increase-age values for different genders. In biological evaluation, as the individual’s growth level increases, the upper limit for height increase decreases. On the other hand, there was a positive relationship between puberty age and creativity of life.
As expected, there was a correlation with the growth of the cavity of life. Height increase decreased when non-biological starting lengths were used in limb lengthening, especially for values above 150 cm for men and 145 cm for women. Three important suggestions have been added to the literature to improve rational reporting in clinical studies on lengthening: 1) evaluating the interaction between growth level and growth velocity on height increase, 2) encouraging individuals to occupy their living
The question of the combined approach safety during simultaneous distractions has to be transferred from the femur and the tibia separately to simultaneous femoral and tibial lengthenings. The single point of concern for the lengthening is the potential of functional impairment related to the nailing as it has been shown that for single, intramedullary lengthenings the femur remains the site with the most functionality decreasing nailing. Most findings on the function-decreasing nailing through the femur remain true also for the full-length KiSi nailing as its distal autostop may cause hard contact with the tibia.
Because of sustaining the positive review from the tibial nailing concerning both the upper tibia and femur during normal gait, the femoral X-ray is only necessary in cases of gam abnormalities requiring nail revision surgery although our experience shows that minor stem tweakings/pushings can heal the gait after femoral nailing also. The issue of respecting the “L4-L5 lumbar spine α-angle” while maintaining the femur mechanical axis during successive lengthening, the one that is a spinal functional parameter causing no change throughout the years, remains.
For patients simultaneously lengthened in both femurs and tibiae the critical questions are if the manual skills of healthy nursing and attention should suffice for handling problems and the discomfort for 2 upper femurs/2 lower tibiae is acceptable even if it complicates sleep at night. Surprisingly, our analysis of the modified Harris Hip score on the entire group with simultaneous lengthenings showed no significant difference in the outcome back at over 1.5 years when the intraoperative pain/dissatisfaction can be disregarded. Our measurements laws raised valid questions, evidently demonstrating that the actual health state influences them less significantly than they do long-term recovery at over 6 months especially when the measured values are taken post-distraction.
Our goal is to improve the quality of life of patients by managing the process of limb lengthening and boot lengthening in a healthy and safe manner.
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