Limb Lengthening Forum
Limb Lengthening Surgery => Limb Lengthening Discussions => Topic started by: Philosopher on July 05, 2023, 03:11:09 PM
-
Considering if someone has bow legs which method is considered the best for lenghtening? Does this condition affect the maximum limit of lenghtening or cause additional complications (like going lower than max 8 femur, 6.5 tibia)?
Also, is there an option that could both fix the condition and simultaneously increase height, or is that not possible?
-
From what I know, doctors usually fix or try to correct bow legs as much as possible during the surgery for LL.
-
To fix the bow legs only one break along the bone is required, and it's the same break that's needed for the limb lengthening.
Bow legs get fixed along the process of doing LL. There is a misconception that bow legs need to be fully straighten out to get fixed which would require more breaks along the bone, but that is not true. All people's bone have a curvature.
One thing to keep in mind is, it's possible to have bow legs, and another deformity, which both cancel each other out, and you grew up having both of those and none of them became an issue individually. If you fix one of these deformities and leave the other untouched, you might cause more issues than you had originally.
I specifically had that happen to me. I fixed bow legs and had a rotational deformity that was left behind, and got way worse without my bow legs, and now I'm in the process of fixing that other deformity (and halfway done) after having already finished my LL journey.
-----
I never understood why people recommend a specific LL method like the hexapod. it makes no sense at all considering that you only break the bone at one place. What additional magic can the hexapod do that other methods can't?
-
Hexapods/rings can be used to gradually change the direction of the bone as it lengthens. Once an internal nail is in there it can only extend in a straight line; it might not even go in if the bowing is severe which is why only mild cases of bowing are correctable with internals.
I knew a guy who was a potential insurance-covered Paley patient, who was single and middle class, who went to China so he could do both at the same time.
-
To fix the bow legs only one break along the bone is required, and it's the same break that's needed for the limb lengthening.
Bow legs get fixed along the process of doing LL. There is a misconception that bow legs need to be fully straighten out to get fixed which would require more breaks along the bone, but that is not true. All people's bone have a curvature.
Are you saying that bowness will fix itself during the lenghtening process itself, even with internals like precice? Also if that's the case might I even end up with an additional cm solely from lessening of the curvature after the lenghtening has been done or not?
-
Considering if someone has bow legs which method is considered the best for lenghtening? Does this condition affect the maximum limit of lenghtening or cause additional complications (like going lower than max 8 femur, 6.5 tibia)?
Also, is there an option that could both fix the condition and simultaneously increase height, or is that not possible?
The best surgical approach depends on the severity of your bow legs.
If your bow legs are of a degree that does not cause problems with your quality of life, it is likely that PRECICE can correct the problem.
The most common complication of tibial lengthening surgery with PRECICE is the knock knee. Patients without bow legs should be aware of the complications of the knock knee during tibial lengthening with PRECICE, but for patients with bow legs, it is a favorable side effect because the deformity is corrected.
Also, even if the average bow leg is corrected, the height will only change by 1 to 3 mm. You can see this by drawing a figure.
To increase height, limb lengthening surgery is required.
-
I assume we are talking about tibias here. What about femurs? In the case of genu varum, the femurs are straight but need to be slanted. How would it work with Precice, if it will work at all?
-
You will not get any noticeable height increase from fixing bow legs in itself. It's really close to nothing.
Bow legs can have different places within the tibia or femur that cause the leg to be bow legged. But that doesn't doesn't matter too much. The docs have leeway in regards to where they can break the bone for lengthening, and they can and will make it so, that the bow leg gets fixed with the spot they choose to break the bone.
The femur alone can be broken above the knee to fix the angle, or somewhere in the mid, or even near the top, depending from where the rod is inserted, or the bone needs to be broken to fix the angle that causes bow legs.
Of course, if bow legs are causes primarily or only by the tibias, but you insist on lengthening femurs, you can't fix bow legs along the way. You need at least choose the right bone obviously. But the method itself is secondary and doesn't matter.
-
I assume we are talking about tibias here. What about femurs? In the case of genu varum, the femurs are straight but need to be slanted. How would it work with Precice, if it will work at all?
You should read the Paley institute booklet.
https://paleyinstitute.org/wp-content/uploads/Cosmetic-Stature-Lengthening-FAQs.pdf
On page 23, it says the following
Axial deviation is a more common problem in the tibia. the tibia tends to lengthen into valgus and procurvatum.
To prevent this the nail should be inserted at the correct starting point, which is very high and as posterior as possible on the tibia on the lateral and To prevent this the nail should be inserted at the correct starting point, which is very high and as posterior as possible on the tibia on the lateral and the frontal plane.
If the nail has space between it and the lateral cortex above the osteotomy, a blocking screw should be inserted in this space.
In other words, the proximal bone fragments are unstable because the diameter of the tibial osteotomy site is larger than the nail.
During the lengthening phase, the proximal fragment is prone to displacement due to muscle forces, and the tibia is prone to valgus deformity.
Blocking screws are used to prevent this, but if the patient originally has Bow-legs and does not use blocking screws, the Bow-legs will be corrected.
However, this is about the tibia, so if your bow-legs are associated with femoral deformity, you will need different approach.