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Oxford University Hospitals NHS Foundation Trust
Limb Reconstruction

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Treatment

In the past, the treatment options for a person with limb length discrepancies were quite limited. Today, thanks to an innovative surgical technique originally developed more than half a century ago in Russia, these individuals may be candidates for treatment that can not only correct the discrepancy, but also address any associated deformity.

Who may benefit from treatment?

People who may benefit from treatment include:

  • patients with limb length discrepancies, as the result of:
    • a poorly healed fracture
    • disease
    • congenital defect;
  • patients who are at risk of amputation owing to missing bone tissue, lost from an infection, trauma or tumour.

The following poster and essay prepared by medical student Rob Middleton and sixth form student Rebecca Littlewood provide further information on:

Treatment process

Surgery (osteotomy)

The process begins with an operation called an osteotomy, in which the orthopaedic surgeon cuts the bone to be lengthened. The limb (usually the upper or lower leg) is then stabilised using one of several different external and/or internal fixation devices or frames.

Treatment Phase 1

In the first, or distraction phase, the bone that has been cut is very gradually pulled apart, in a process that promotes distraction osteogenesis, or new bone growth, at the site of the osteotomy.

Continued growth of new bone tissue is accomplished by adjusting nuts and bolts in the frame. Generally the rate of correction is 1 mm per day but there are variations.

As the space between the ends of the bone opens up, the body continues to produce new tissue in the gap until the desired length of bone has been generated. The new bone formed initially is soft, and does not show up on X-rays. It gains strength gradually.

Additional adjustments may be made to the fixation devices to correct any deformity that may be present, such as a misalignment of the bone resulting from trauma.

Treatment Phase 2

During the second phase of treatment the bone consolidates and heals. The patient gradually puts more weight on the affected limb, and starts walking without crutches.

X-rays confirm when the new bone is completely healed. The fixation device is then removed and the patient may function normally.