Limb Lengthening

Its pretty amazing that you can lengthen a bone. Actually you don't lengthen it, you grow it. Amaya grew  new bone. When she was six years old she grew 3.2 inches of new bone and soft tissues. It was an amazing experience! At times painful but also filled with moments of strength. It is amazing to write that, 3.2 inches! 

If you're not sure how limb lengthening works here's a bit of what I know. Typically in other surgeries they do the procedure to correct, add or remove something then within a few days or so you being to recover. Lengthening is different in that it's a process. The initial surgery is to break the bones that will be lengthened and to insert the device and then the lengthening process begins. It takes time to complete the lengthening and to heal from it.

There are three phases to lengthening latency, distraction and consolidation.

Latency phase...there is a pause in the process to allow for rest. This happens once the lengthening device is inserted and lasts about 5-7 days prior to beginning the lengthening process.

Distraction Phase...this is the gradual process of pulling apart the bone. New bone (regenerate bone) is created in the space. The bones are pulled apart slowly (about 1 mm per day usually done in three or four times throughout the day). As the bones are continually pulled apart new bone is created, and soft tissues grow (blood vessels, skin, muscles, nerves, etc). Frequent x-rays are important during this phase so that bone isn't created too slowly (if so then the bone can begin to harden prematurely) or too fast (this can lead to unhealthy bone). Patients must have regular physical therapy to help grow soft tissues and to ensure that range of motion isn't lost. 

Consolidation Phase...during this phase the new bone begins to harden and calcify. This can take about twice as long as the distraction phase did. Weight bearing is usually increased during this time to encourage healing. The lengthening device is still worn during this time. 

Last time Amaya had an external fixator to lengthen her bone. She grew 3.2 inches, had physical therapy nearly every day and she wore her fixate for seven months. Below is an x-ray of Amaya's femur & fixator from last time. 

This time Dr. Nelson will be doing a lengthening using the Precice nail technique. Rather than an external fixator she will have an internal rod. This should be much easier and less painful. The internal device is much more comfortable has no pin sites (basically open wounds we had to clean and dress daily. This was the greatest source of pain for Amaya last time). This time she is only growing 2 cm (about .78 inches) so that is a much less time to lengthen. We can lengthen 1 mm per day so that's 20 days to lengthen. Then it should be about another month or so to consolidate her new bone. She will wear the device for about a year and then will have it removed next year (and he will work on her knee then). 

Dr. Nelson has created a video showing how the Precice nail is inserted and he talks about how it works. The video has a clip of a real surgery so if you're a bit squeamish you might want to skip through that part (3:45 to 8:40). I'll be honest it was much easier for me to watch this prior to having Amaya's surgery scheduled, now that it is I can't bring myself to watch it. Back then I found this informative, helpful and interesting. Now it makes me squeamish and emotional so I've stopped watching it. I'm glad I watched it before so I know what will be happening and how he will do it. 

If you'd rather skip the video here's some photos that shows what it looks like. 

All these pictures are from the Int'l center for limb lengthening at Mt. Sinai and can be viewed at limblength.org. They also have other videos and information that are pretty helpful especially if you're going to be starting a lengthening soon.