Limb Lengthening - Now Actually Easier Than in the Movies!
In the 1997 film Gattaca the main character undergoes limb lengthening surgery to be taller so that he can assume the identity of another person. In this brief clip (sorry for the poor quality, its the only one I could find) the surgery is briefly discussed, and the apparatus is shown. For dramatic effect they imply that this is a torturous procedure and show a classic Ilizarov type external fixator - which can certainly look intimidating. However, for a movie that is set in the future, 20 years later we already have technology that substantially surpasses what was deemed to be"futuristic" in the film.
I could go on and on about the history of limb lengthening, but let me try to summarize it briefly. In the 1950's/1960's Professor Garvrill Ilizarov discovered that if you cut a bone and slowly pull the two ends apart, new bone will form in between. This is a process called distraction osteogenesis and was perfected in Siberia during the Cold War by Professor Ilizarov with little transmission of this knowledge to the rest of the western world until the 1980's and 1990's. The process utilizes bone's inherent ability to regenerate and essentially mimics normal growth - wherein the soft tissues around the bone grow in response to the elongation of the bone, and so the whole limb can slowly be lengthened with new tissue - and not just "stretched". As originally developed by Ilizarov this technique utilized an external fixator, which is still used frequently for certain applications, but more recently there has been a significant advance in the technology and now lengthening can be accomplished using all internal hardware!
Over the past decade+ several iterations of internal lengthening nails have been developed in order to make the process easier for patients. The nail with which I am most familiar is the Precice Nail from Nuvasive (Formally Ellipse), which is a magnetic internal lengthening nail controlled with an external remote control. Below is an image (courtesy of Nuvasive) of one of the nails and the remote control unit. Note: I have no financial interest in Nuvasive, or any other orthopaedic device company.
After osteotomy (cutting the bone) is complete, the nail is inserted into the medullary cavity (inside) of the bone and after 4-7 days lengthening is initiated (depending on the bone and the age of the patient). In the femur, lengthening generally progresses at 1 mm/day and so a 2 inch lengthening takes about 50 days to distract, and then usually about 6-8 weeks before the bone is healed enough to put full weight on the leg.
More to come on bone lengthening in later posts - this is a great topic, but for now here is a recent case I did with my mentor Dr. S Robert Rozbruch. The patient is an adolescent male with a congenital leg length discrepancy treated with a Precice femur nail. He had about 1 inch of discrepancy, and as a result of his young age was healed to the point of full weight bearing just 7 weeks from the time of surgery! Below are the images from immediately after surgery, and at the time of transition to full weight bearing.
Case courtesy of S Robert Rozbruch, MD