THE LIMB-LENGTHENING PROCESS – SURGERY, DISTRAction, AND CONSOLIDATION, STEP BY STEP

Bone lengthening surgery – osteotomy and soft tissue preparation

During the procedure, the surgeon cuts through the bone, dividing it into two fragments. This procedure is called an osteotomy. At the same time, additional procedures may be performed on the soft tissues to prepare the muscles and nerves for the lengthening process. For example, surgical lengthening of the Achilles tendon facilitates the lengthening of the tibia (lower leg bone).

During the procedure, the doctor will also attach or implant an orthopedic bone-lengthening device. This may be an internal device, such as the PRECiCE nail. There are also external fixators that remain outside the body, such as the Vilex Hexapod, SmartCorrection, DialMedicali Frame, or even the standard Ilizarov apparatus.

The recovery phase following limb-lengthening surgery

After the procedure, a waiting period of five to seven days is observed, during which repair processes begin between the bone fragments. This is known as the delay phase. Once this phase is over, the patient (or their caregivers) adjusts the device settings, slowly moving the bone fragments apart.

Distraction phase – gradual bone lengthening

This process is called the distraction phase, or lengthening. As the fragments are moved apart, the defect site fills with newly formed bone tissue. In this way, the bone is lengthened. The resulting bone tissue is called bone regenerate.

During the distraction phase, the patient (or a caregiver) adjusts the device settings daily, causing the bone segments to be slowly pulled apart at a rate of approximately 1 mm per day. The rate of lengthening may vary slightly depending on the bone. For example, tibial distraction may proceed at a rate of 0.75 mm per day, while femoral or humeral distraction may proceed at a rate of 1.0 mm per day.

Gradual stretching forces the body to continuously generate new bone and soft tissues, such as skin, muscles, nerves, and blood vessels. The distraction phase continues until the desired bone length is achieved. It is possible to gain approximately 2.5 cm of additional length per month.

During the distraction phase, the patient comes in for follow-up visits several times a month to ensure that the rate of lengthening is appropriate. Based on an evaluation of bone regeneration on X-rays, the doctor may increase or decrease the rate of distraction. Throughout this process, the patient must attend physical therapy two to five times a week and exercise daily at home according to the instructions provided.

Consolidation phase – transformation of the callus into mature bone

The distraction phase is followed by the consolidation phase, during which the bone callus gradually hardens and transforms into bone. In a typical 5-cm limb-lengthening procedure, it takes about 2 months to achieve the desired length increase, and another 2–3 months for the new bone to mineralize.

In such cases, the lengthening device remains in place for at least 4–5 months. The healing process can only be considered complete once the new tissue has remodeled and calcified. To support the healing process, patients should avoid nicotine, follow a healthy, protein-rich diet, and take vitamin and mineral supplements.

During the consolidation phase, the doctor will recommend gradually bearing weight on the limb (using crutches or a walker), which promotes bone remodeling. By the end of treatment, the patient will be able to stop using crutches. Once full consolidation of the bone graft has been achieved, the lengthening device can be removed on an outpatient basis. In the case of an external fixator, the doctor may additionally recommend a cast or brace for 3–4 weeks.