Cosmetic Lower Limb Lengthening by Ilizarov Apparatus: What are the Risks?

Abstract

Background Compelled by the psychosocial implications of short stature, patients with short stature are increasingly undergoing distraction osteogenesis for cosmetic limb lengthening. To the degree that this is true, evaluation of the risks and benefits of this treatment are very important, but to date, there are few studies reporting on using distraction osteogenesis for this indication. Questions/purposes We reviewed a group of patients undergoing cosmetic lower-extremity lengthening in terms of (1) soft tissue challenges, (2) bone-related complications, and (3) functional and subjective clinical outcomes. Methods The study was retrospective by reviewing data from medical records and radiographs. Between 1983 and 2006, we treated 138 somatically normal patients with bilateral lower-limb distraction osteogenesis for cosmetic purposes at our center using an Ilizarov external fixator, of whom 131 (95%; 65 males, 66 females) had complete clinical and radiographic data a minimum of 1 year after treatment (mean, 6 years; range, 1-14 years) and were reviewed for this report. The mean age of these patients was 25 years (range, 14-68 years) and their mean preoperative height was 159 cm (range, 130-174 cm). One hundred twenty-four (95%) patients had lengthening of the tibia alone, of which 66 (53%) were monofocal and 58 (47%) were bifocal. Six patients (4.58%) had crossed contralateral lengthening of the femur and tibia and one patient (0.76%) had bilateral lengthening of the femur. The mean height gained was 6.9 cm (range, 2-13 cm), 7.3 cm (range, 3.5-13 cm) in males and 6.5 cm (range, 2-13 cm) in females. The mean lengthening, maturation, and external fixator indexes were 12 days/cm (range, 4.3-24 days/cm), 19 days/cm (range, 5.2-63 days/cm), and 31 days/cm (range, 12-78 days/cm), respectively. Results Forty-eight patients (37%) had 59 complications related to treatment. Thirty-seven were soft tissue related (28%), of which 17 (46%) needed reinterventions, and 22 were bone related (17%), of which 16 (73%) needed reinterventions. At final followup, the outcome was excellent for 72 patients (55%), good for 52 (40%), satisfactory for six (4.58%), and poor for one (0.77%). One

CORR Insights®: Is there an Increase in Valgus Deviation in Tibial Distraction Using the Lengthening Over Nail Technique?

“…Complications are common in cosmetic bone lengthening procedures, and they can be severe [3]. As previously suggested [2,4], longterm studies on cosmetic limb lengthening evaluating limb function and patient gains, including psychological validated outcome measurements, are warranted.…”

Gait analysis in children after the lengthening of the lower limb by the Ilizarov technique

“…Zaletą takiego postępowania jest możliwość wielokierunkowej oraz wielopłaszczy-znowej korekcji osi kończyny podczas jej rozciągania. Dodatkowo, stabilizator zewnętrzny Ilizarowa zapewnia dobrą stabilizację wydłużanego segmentu ruchowego [1,2,3,4,5]. W czasie leczenia tą metodą konieczne staje się wyrobienie i utrwalenie prawidło-wych wzorców ruchowych, co wymaga bardzo dłu-giego czasu.…”

“…The advantage of such a procedure is the possibility of multi-faceted and multi-planar correction of the limb axis during its elongation. In addition, the Ilizarov external fixator provides good stabilization of the elongated segment of the locomotor system [1,2,3,4,5]. During Ilizarov treatment patients have to learn and adopt correct movement patterns, which requires a very long time since locomotor automatism is established after approx.…”

What’s New in Limb Lengthening and Deformity Correction

“…Given the lack of evidence-based guidelines and the emerging popularity of internal limb-lengthening implants, the indications for stature lengthening are debatable. Studies evaluating the effect of limb lengthening on the physical and psychosocial health of individuals undergoing stature lengthening are strongly encouraged 104,[109][110][111] .…”