Limb lengthening surgery is a relatively new medical procedure that has come into prominence in the last few decades. Limb lengthening procedures are gaining more popularity as more and more individuals have sought limb lengthening services for either cosmetic reasons or correction of unequal leg length or arm length due to congenital disorders, fractures, or discrepancy in growth.
A gradually elongated bone that is created by the newest surgical and biomechanical technologies is referred to as bone lengthening. Bone lengthening is utilized specifically in limb lengthening and deformation correction. The particular lengthening procedure selected is based on the age limit limb lengthening surgery, the volume of lengthening required, the chosen method of bone lengthening, and other individual factors. In children, bone lengthening surgery allows the surgeon to lengthen the limb by exploiting the primary growth of the child’s own tissue.
In veterans who have received therapy to manage war-related injuries, compassionate-use clinical treatments have been tried. Growth-plate cartilage at the knee of a rabbit was damaged as an experimental model of post-traumatic growth arrest. The subsequent untimely closure of the damaged cartilage plate was leveraged for tibial bone lengthening. In both the test animals and the healthy controls, tibial bone lengthening was monitored longitudinally on X-rays and quantified. Although surgical trauma disrupted the growth-plate cartilage mobile lesion, the damaged growth plates healed, and limb elongation in the test group rabbits followed the control group.
Several anatomical, physiological, psychological, social, and financial factors are considered to delight a patient candidate. All these factors also support the decision-making process regarding the appropriate age at which to commence surgery, to achieve an effective total height gain, while simultaneously curbing the impact of complications for the internal organs and a diminution in quality of life. According to current knowledge, psychology plays an essential role in limb lengthening surgery; a patient who undergoes surgery due to emotional instability often ends up disappointed with the results, and dejected by the long journey they have taken. Surgeries performed due to emotional instability frequently are performed in a psychologically unstable person. Tebbetts showed that the age limit imposed on female cosmetic surgery in the United States is an outcome of the aesthetic surgeon’s experience, and he stated that this threshold is an informal social yardstick.
In patients older than 20, and especially those older than 30, the stiffening of the collagen fibers for the epiphyseal plate slows in speed. In contrast, however, the younger the individual, the faster the closure of the epiphyseal plates. In limb lengthening surgery, studies report that surgery performed on patients under 20 is more laborious and cannot be exited. This leads us to recommend that cosmetic surgery for height gain and congenital leg length deformities take place prior to reaching the age of 20. At the same time, such a threshold of 18 to 20 years is recommended on account of the social and psychological difficulties individuals experience as they grow older. The legal age limit limb lengthening surgery in most countries to undergo cosmetic and elective surgery is 18, partly due to the fact that minors may make ill-advised surgical decisions, and partly because their body phenotype and personality have not yet been fully established.
Over the years, an increase in the demand for limb lengthening procedures has been observed. These days, more and more parents contact surgeons with a proposal for limb lengthening in respect of their children under the minimum age for limb lengthening surgery of 18 years. Limb lengthening surgeries and age have long been a subject surrounded by controversies and discussions related to the minimum age for limb lengthening surgery for children who can undergo such surgery. The aim of this article is to outline the minimum limb lengthening surgery age requirements and critical aspects to consider in respect of children entitled to undergo limb lengthening surgery.
For surgery to be possible, it is necessary for the bone to grow at two places of a metaphyseal cartilage plate on its two diametrically opposite ends. This phenomenon occurs at the wide parts of the long bones. The bone is actively growing and elongating day by day, usually until the age of 16-18 years. Only after the epiphyseal closures occur is the bone length no longer capable of increasing. It is not possible to initiate that process any earlier than that. Therefore, the bones of very young children cannot be lengthened using the methods used in bones of preadolescents, adolescents, or adults. In over 90% of all lengthening cases, the treatment is performed in bones. There is no doubt that in terms of human anatomy, physiology, and development, a person under 18 years old is unable to undergo limb lengthening surgery. An analysis of the limb lengthening surgery age requirements at which surgeries of this type have been performed does not definitively answer this question. The ethical aspect suggests that once it is possible, we should attempt to address not only the scientifically admissible issues but also the socially acceptable ones.
The issue of the maximum age limit limb lengthening surgery at which a person should be allowed to undergo a limb lengthening surgical procedure is presented. This topic is still a matter of debate because it is difficult to deduce the physiologically determined subjective age limit. Due to the physiological reasons mentioned above, patient lifestyle should also be taken into account when determining the feasibility of the limb lengthening procedure. Furthermore, the setting of the maximum age for limb lengthening surgery is associated with the social and medical implications of such decisions.
Physiological conditions establish that there is no upper age limit limb lengthening surgery. Many factors such as bone healing time, energy and time needed for physical therapy, or body response to surgery depend on the current state of health of an individual and may be diminished by other comorbidities. Almost any age is embraced by medicine for normal treatment, and limb lengthening has no known maximum age limit limb lengthening surgery. As assumptions of limb lengthening surgery in older people have certain ranges, lifestyle rather than absolute age determines patient suitability. Medicine distinguishes several categories and severity of limb length discrepancy but does not take patient maximum age for limb lengthening surgery into account. Setting any age boundary would, therefore, reflect—instead of biological or medical standards—the ethical and economic conditions and limitations to be considered by society and policymakers. Setting maximum age for limb lengthening surgery has sociomedical implications that need to be taken into account. The inexorable aging of the world population means that both children and seniors are becoming second-rate citizens.
Age limit limb lengthening surgery is a significant factor that is associated with the bone tissue regeneration process and the degree of complications related to bone tissue reconstruction. However, the age limit of limb lengthening surgery is unclear. A literature review clearly shows that the age factor is related to bone regeneration and original skeletal capacity and should be the most important consideration of bone reconstruction in young people in clinical practice. Therefore, we hypothesized that a patient aged 50-60 years may have an increased risk of bone and medical complications by orthopedic surgeons who have undergone system upgrading, given our bone regeneration ability combined with sympathetic activity and menopause in clinical practice when the number of surgical procedures can be doubled, depending on the outcome of the first session. To further this research, a large-scale multicenter study is needed on patients who undergo limb shortening for trauma or wages.
The similarities and differences between these characteristics and those of adults, such as partial bone growth originally occurred by retention and some muscles and tendons, should be more clearly clarified. In addition, insights obtained through the high-fat meal model may also facilitate ongoing research activities exploring the association between age and lipid metabolism in bone repair, leading to further exploration of whether simvastatin treatment may restore callus stability in patients with bone regeneration-related osteoporosis (elderly). Finally, a large randomized controlled study is needed with a significant number of patient cases to identify whether the results obtained by regression analysis in the article can be applied during the process of periosteal distraction osteogenesis for limb reconstruction. A consensus among surgeons must verify that the future findings can effectively produce for surgical operations.
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