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Techniques for lengthening. Prof Dr Khaled Emara Ain Shams University Cairo, Egypt. UPPER END. SHAFT. LOWER END. The lengthening site. The first step in lengthening is we the -Orthopaedic surgeon- make a surgical cut in the bone by a special technique
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Techniques for lengthening Prof Dr Khaled Emara Ain Shams University Cairo, Egypt
UPPER END SHAFT LOWER END
The lengthening site • The first step in lengthening is we the -Orthopaedic surgeon- make a surgical cut in the bone by a special technique • This cut act as a growth center for the bone • The direction of growth & stability of the bone till we finish lengthening is controlled by several fixation devices & techniques
Techniques of fixation & lengthening • Pure external fixation (old classic ) • External fixation for lengthening over a nail • External fixation & lengthening then early removal & replacement by a nail once lengthening is finished • Internal lengthening nails with out external fixation
External fixation • It is an old technique have been used for a very long time • It is effective & safe • But it is uncomfortable for the patient as the external fixation stay for a long time in the leg (about one month for every centimeter lengthening) • Need close follow-up & care by the patient & the doctor
Gradual: • uniplanar VS. circular X FX
Risk of infection at the pins of the external fixation or soft tissue irritation is the most common problem (usually a minor problem) controlled by frequent cleaning & antibiotics • The patient discomfort due to the bulky device which can limit the activities during lengthening • Need regular cleaning of the pins & physical therapy for the muscles & soft tissues • It give better control over the lengthening & soft tissues as the muscles & nerves
Internal lengthening devices • More comfortable fro the patient as the lengthening device is inside the bone not out side the leg • But less control on the device as it can go faster or slower than required for lengthening, this can cause new bone callus problems as premature healing of the lengthening center in the bone before finishing lengthening
Also it can cause too rapid lengthening with much stress on the muscles & joints & nerves & this can be harmful to the function after lengthening • Nail jamming or mechanical problems that can happen during lengthening • The control over that device is not as good as the external fixation device • More expensive
Lengthening over nail • This can be used to put a nail inside the bone & lengthen the bone by external fixation device till finish lengthening then we remove the external fixation & fix the nail finally at the new bone length so we don’t need to keep the external fixation device till full maturation of the new bone
This technique give shorter duration of external fixation (1/3 the pure external fixation technique) • This give more comfort to the patient & earlier rehabilitation & regain of muscle power & joint range of movement • There is higher risk of deep bone infection than other techniques
Lengthening then nailing • Remove the external fixation device once we finish lengthening & replace by a nail at the new length • This technique has the same advantage of lengthening over nail but with much less risk of infection & more patient comfort • We recommend this technique as it is safe & effective
Thanks • Dr Khaled Emara • 13 B Kornesh EL Nile, Agha Khan, Cairo, Egypt • Tel: (202) 2055661, (202) 2055664 • Tel: (2012) 2513929 • Fax: (202) 2055662 • Email: kmemara@hotmail.com • Web site: www.khaledemara.com