How limb lengthening transforms lives

Leg-lengthening surgery is a new cosmetic procedure that can make short people’s wish to be taller come true.  In this report by Sade Oguntola, experts say it is also corrective of severe limb deformities and shortened legs from injury, fracture and diseases such as rickets.

The discrepancy in Henry’s limb was noticed when he started walking fully and putting weight on the leg. Doctors suggested putting a cast on the curved legs to straighten them.

Henry is not an exemption, little Chinyere was also born with knock knees. When standing, Chinyere’s knees will be touching each other while her feet and ankles remain wide apart.

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In growing children, limb deformities of the legs, including bow legs and knock knees, are among the most frequent causes for a visit to the paediatric orthopedist. In many cases, the deformity corrects naturally. However, in those cases where the condition persists or the abnormality becomes more pronounced, medical attention is required.

Children who are born with or who develop differences in the length of their limbs can benefit from a range of treatments that may be as simple as the use of adaptive footwear or as sophisticated as limb lengthening surgical intervention that helps generate new bone in the affected limb.

Dr Micheal Okunola, a consultant orthopaedic and trauma surgeon, with subspecialty in limb lengthening and deformity correction at the University College Hospital (UCH), Ibadan, Oyo State, stated that children with limb deformities have differences in the way their arms or legs are shaped. Their legs may be curved or one might be shorter than the other. Or, a bone in the arm may be short or missing.

Signs of a limb deformity depends on which limb is affected and how severe the deformity is. Some limb deformities are so mild that they are not noticeable. Others are quite noticeable and affect the way a child moves or walks.

Okunola, head, Department of Orthopaedic and Trauma, UCH, Ibadan stated “there are different causes of leg deformity. Some patients are born with it; some are developmental. As the child develops, they come up with this deformity.”

Some limb deformities are as a result of infection eating up the growing part of the bone and so the patient comes up with deformity and shortening of the affected leg. Some occur as a result of a fracture to the limb and a segment of the bone lost following a road traffic accident.

Other causes include rickets. Rickets is a bone disease in children that causes bow legs and other bone deformities. Children with rickets do not get enough calcium, phosphorus, or Vitamin D — all of which are important for healthy growing bones.

Rickets can also be caused by a genetic abnormality that does not allow Vitamin D to be absorbed correctly. This form of rickets may be inherited.

“At the University College Hospital, Ibadan, we have been working on correcting bow legs, what is termed Blount’s disease in medical parlance, using the Ilizarov technique.

“Bowed leg is a common developmental problem that many people are not aware of can be corrected. The few people that seek to have it corrected seek attention at traditional bone setters, which most times usually end up with complications,” said Dr Okunola.

Bowed legs are most evident when a child stands and walks. The most common symptom of bowed legs is an awkward walking pattern. Turning in of the feet is also common in toddlers and frequently occurs in combination with bowed legs.

Bowed legs do not typically cause any pain. However, a persistent bowing can lead to discomfort in the hips, knees, and/or ankles because of the abnormal stress that the curved legs have on these joints.

Dr Okunola declared that deformity-correction surgery is a new subspecialty of orthopaedic surgery in Nigeria that UCH, Ibadan is leading its development. Before now, people used to go abroad to do some of these corrections.

He stated: “We have been doing this surgery in UCH for the past five years. That is why we are spearheading a limb-lengthening and deformity-correction workshop in the third week of June so that we can train more orthopaedic surgeons from all over Nigeria. They can then be correcting this deformity in their various centres using the method.”

Okunola, secretary, the Limb Lengthening and Reconstruction Society of Nigeria (LLRSN), however, explained that the surgery involves more than straightening of deformed limbs.

According to him, individuals with shortened limbs due to bone loss from fracture or bone infection can also restore the length of their affected limbs back to normal.

Also, the corrective surgery can also help dwarfs to attain an average height as well as for cosmetic purposes such as straightening of ladies legs and men wanting to grow taller to improve their appearance and feel better about themselves.

Dr Okunola, however, solicited financial support from well-meaning Nigerians and philanthropists to treat indigent patients with defective limbs.

According to him, “Like Honourable Saheed Akinade Fijabi, we will like people to support the indigent children with limb deformity for surgery, too.”

Bone lengthening and correction of deformity came based on the knowledge that when the bone breaks, it naturally regenerates to fix the fracture. Lengthening works by separating the bone and distracting (pulling apart) the bone segments very slowly so that new bone continues to form in the gap. As the bone segments are slowly distracted, the bone regenerates, resulting in increased length.

Limb lengthening surgery was pioneered in the 1950s by a Soviet Professor Gavrill Illizarov in order to treat World War II veterans with leg injuries. The device that performs the lengthening is called a fixator. A variety of fixators are used. They can be divided into two categories: the external fixator and the internal fixator or implantable lengthening nail.

External fixators are devices that attach to the bone through wires and pins. The external fixator looks and acts like a scaffolding, supporting the separated bone. The fixator mechanically lengthens the limb by pulling the segments of bone apart.