Almost all limb malpositions and limb extensions can be corrected. Longitudinal, axial and rotational misalignments can be corrected in one go or by means of callus distraction.
The following techniques are used, among others:
- Plate fixation (e.g. Tomofix®)
- Ilizarov technique (Spatialframe®)
- Intramedullary Extension Nail (ISKD®)
- Growth control: (hemi-) epiphyseodesis
Cosmetic Bone Surgery or Functional Necessity?
Who does not remember bow-legged football players or a crooked, limping gait through unevenly long legs? Orthopedic surgical operations can help both. Because crooked and unevenly long legs are not only cosmetically annoying, they also lead to premature joint wear and thus to pain.
Improved surgical techniques and modern implants have made proven correction methods safer and less painful for the patient.
Misalignments of the extremities, i.e. crooked, twisted or unevenly long legs are usually caused by accidents, but can also result from growth disorders.
First of all, it is important to determine what type of deformity is. This means that there is an axis error, for example bow or knock knees, a difference in length or a twist.
The type of misalignment also determines the surgical method of correction.
In this way, differences in length of up to 8 centimeters can be compensated for using what is known as callus distraction. Simple axis errors, such as O or X legs, are usually corrected in one operation, the bone is severed, put back together correctly and stabilized using modern, highly stable plate systems.
Provide an overview of the current correction options:
- Ilizarov technique - how the bone is made to grow again:
This method came to Europe from what was then the USSR as early as the 1980s. The so-called "Ilizarow technique" named after its Russian developer revolutionized the correction of misaligned limbs.How does this technique work:
In rings, the bone that has been severed at the planned point is stabilized by tensioned wires, like the axis of a spoked wheel. The ring connections can now be used to control the formation of new bone in the desired direction. In this way, length, axis and rotation corrections are possible. Computer-aided control of this process has recently made it possible to correct even difficult misalignments precisely to degrees and millimeters.
Functional aesthetics through correction of extremes: With this system, practically all corrections are possible, including bone lengthening, tilting and rotation. Crooked legs of unequal length can become straight and the same length again. The cosmetic and functional gain can be great.
However, the burdens and risks must be weighed against the benefit that can be expected for the patient.
Leg lengthening is only possible by one millimeter per day, and the bone takes another two to three days per millimeter to set. An extension of three centimeters therefore takes four to six months. An "external stabilization system" (e.g. the Ilizarow device) must remain attached to the patient's leg for this time.
For the patient, this means daily cleaning of the wounds and the apparatus, restrictions in mobility and clothing, as well as regular checks by the doctor.
- Leg lengthening with intramedullary nails:
Leg extensions are even easier with extendable intramedullary nails, the latest development in this field. Extensions of up to 8 cm are possible. The external stabilization apparatus, which is a nuisance for the patient, is no longer necessary. How does this system work: The thigh or lower leg bone is severed at the planned location and stabilized with an intramedullary nail. The special thing about this nail is that it can be extended. A built-in ratchet mechanism converts small rotary movements into length gains via a threaded rod. For the patient, months of being disabled by an external stabilization apparatus are no longer necessary. Our experience shows that although this system is more comfortable for the patient, it means less flexibility for the practitioner. All corrections must be determined at the time of nail implantation. Post-corrections are no longer possible. The planned extension is set on the nail and the patient's progress is monitored by means of a sensor system.
- Simple bow legs can be safely corrected with new implants:
Less pronounced axis errors such as bow and knot legs are usually not so cosmetically annoying. Nevertheless, they mean an increased risk of developing joint problems. A poor mechanical axis can lead to premature cartilage wear, i.e. osteoarthritis, by overloading a section of the knee joint. Correction of the leg axis is the surgical method of choice for joint-preserving arthrosis prophylaxis and therapy. Simple corrections are carried out one time, i.e. in one operation. How does this happen: The bone is cut at the planned point and reconnected in the corrected position using modern, extremely stable plate systems. The patient is allowed to get up again the next day and put some weight on it. He can usually leave the hospital after less than a week. If necessary, an anterior cruciate ligament repair or cartilage surgery (cartilage transplantation and implantation of cultivated cartilage) can be carried out in one session. Surgical bone correction should be more than a cosmetic procedure for the patient. It is supposed to improve and restore the function of a part of the body and thus enable a life without pain.