| |
|
|
|
Phase 1: Consultation and Initial Evaluation
You will be met by the General Director of the Ilizarov
Centre for Traumatology and Orthopaedics as well as your
appointed orthopaedic surgeon. After a rudimentary physical
evaluation and discussion of your desired height goal,
the meeting will proceed regarding our recommended best
course of treatment according to your requests. All aspects
of the Ilizarov lengthening procedure will be conveyed
to you and translators will be present during the meeting
for the aid of communication and clarification.
Phase 2: Preparation and Preoperative Visit
It is required that a comprehensive physical examination
be performed for each patient before surgery. These are
completed at the Ilizarov Centre by our range of specialist
physicians. Depending on your age and health status, assessments
such as blood tests, electrocardiography, and radiography
of the tibias or femurs are required prior to the surgery.
As part of the preoperative visit, informed consent will
be obtained and questions regarding the surgery will be
answered. At this point your surgeon will determine the
appropriate sized frames which will support you during
the lengthening and consolidation process. You will also
be scheduled a meeting with your anethesiologist before
undergoing your surgery to discuss any allergies or specific
requirements that you may have.
Phase
3: Surgery For lengthening, a corticotomy on
the appropriate bone is performed through a small incision
to minimise injury of surrounding tissue. The external
fixator Ilizarov frames are then attached to the bone
using pins that pass through the tibias/femurs depending
on which bone is to be lengthened. After surgery, patients
remain in the hospital for the entire duration of their
treatment so as to ensure that the risk of complications
are minimised. Immediately after surgery you will receive
constant monitoring by our team of qualified nurses and
daily post-operative visits by your doctor. Our physical
therapists initiate rehabilitation sessions a few days
after surgery and patients are taught to walk using crutches
ensuring that they remain physically active during the
lengthening and consolidation phases.
Phase
4: Distraction
Phase Lengthening usually begins a few days or a week
after surgery. At the Ilizarov Centre, this is done either
manually or by means of motors. The manual turns are performed
by the Centre's nurses and the motors run automatically
however can be turned on or shut down manually. As bone
is a living substance, when its ends are gradually distracted,
new bone grows between the two ends. The lengthening rate
is usually 1 mm per day but may be slower or faster depending
on the tolerance of the bone and soft tissues to the distraction
process. Most patients experience little pain during the
day. Aching or difficulty sleeping at night is not unusual
but is well controlled with medications as required. This
varies between patients according to individual pain tolerance
and the type of treatment being performed. Physical therapy
is required on an inpatient basis in all cases during
the distraction phase. These sessions are designed to
stretch muscles assisting their growth and to maintain
joint flexibility. In most cases, we allow partial or
complete weight bearing as this process stimulates new
bone to grow - much in the same way stretching stimulates
muscles and other soft tissues to grow. During the distraction
phase, you will be examined and x-rays will be obtained
every two weeks to evaluate bone growth, nerve and muscle
function, and pin sites. The distraction rate will be
constantly adjusted by your doctor according to the strength
of your regeneration and your body's tolerance of the
lengthening process. A feature unique to the Ilizarov
method is that correction to the lengthening bone can
be performed due to the frames completely surrounding
it in a 360° fashion. Corrections are essential during
the distraction process as it ensures that both bones
ultimately are of equal length as well as shape. This
results in the optimum desired aesthetic effect being
achieved for our patients.
Phase 5: Consolidation Phase
After the desired lengthening has been achieved, adjustments
and correction with the Ilizarov frame cease. Newly regenerated
bone is weak at this stage and would be unable to resist
compression or fractures without the continued support
of the external fixation device. Thus, the external frame
remains in place until the end of the consolidation phase.
The average total external treatment time is 1 month per
centimeter (therefore achieving 5cm in height should take
approximately 5 months to complete including the distraction
and fixation phases). Bone regeneration and the levels
of calcium present is assessed according to patient x-rays.
Phase 6: Removal of the External
Frame
Once sufficient calcium is identified throughout the regeneration
region, the apparatus is then removed through a brief
non-surgical process causing very little pain or discomfort
for the patient. After removal, patients are required
to wear a cast for one month as a form of additional protection
of the newly generated bone.
Phase
7: Rehabilitation Phase
At our Centre it is standard for patients to walk and
perform normal tasks and functions after their casts are
removed. Our specialist physiotherapists will work with
patients through a comprehensive rehabilitation program
to restore all normal leg and foot functions. When deemed
appropriate, assessments by your doctor and the Centre's
general director will be conducted to ensure that functionality
is restored prior to patients being released from our
Centre.
 |
|
Patient R., age 22,
underwent lengthening of both tibias by Ilizarov
method of bilocal distractive osteosynthesis.
Lengthening 7 cm. |
|
 |
 |
|
Patient, age 34, underwent
lengthening and axial correction of both tibias
by Ilizarov method of bilocal distractive osteosynthesis.
Lengthening 5 cm. |
|
 |
 |
|
Patient, age 25,
underwent lengthening of tibias and subsequently
femurs by Ilizarov method of bilocal distractive
osteosynthesis. Lengthening 14 cm. |
Distraction Pain
Pain during the distraction process is a standard consequence
of any lengthening technique. Most patients do not experience
extensive pain in the day however difficulty attaining
adequate amounts of sleep is a common occurrence during
the distraction phase. These are controlled with the aid
of medications according to the individual requirements
and tolerance of each patient. Pain encountered during
the distraction process is due to the accompanying lengthening
of soft tissues such as muscles and tendons. Thus, once
fixation has been achieved all pain encountered from distraction
dissipates within a few days and is no longer an issue
during consolidation.
Soft Tissue Contraction
While lengthening bone, it is necessary to practice physical
therapy to ensure that tendons and other soft tissues
are expanding proportionally. However, contraction often
occurs as a consequence of muscle weakening and patient
inactivity during the distraction process. This prevents
the patient from completely straightening their leg and
occurs in varying degrees depending on the severity of
each circumstance. The condition however is temporary
as contracted tissues such as muscles and tendons are
soft and flexible in structure. It is therefore invariably
rectified during the consolidation phase through implementing
the Centre's appropriate physiotherapy exercises and stretches.
Due to our 50 yrs experience in treating thousands of
height increase cases, the Centre possesses one of the
world's most developed exercise programs specifically
devised to address tissue contracture. And although physical
therapy may appear to be a trivial issue, it is in fact
the sole determining factor which renders a height increase
procedure as either a success or a failure.
Numbness
Many patients experience numbness in limited areas around
the feet following surgery and while distracting. This
is caused by post operative swelling thus inhibiting proper
nerve function during lengthening. Sensation is gradually
restored during fixation as nerve irritation and swelling
has ceased during this phase with patients recovering
their full sensations.
Scarring
Scarring is a prevalent issue when lengthening with the
Ilizarov method. As metal pins are utilised to support
the bone, scars form on the skin due to the stretching
incurred while distracting. The Centre offers scar treatment
additional to height increase in order to assist with
the cosmetic aspect of this procedure. Results are aesthetically
extremely effective and scar removal has now become a
very common procedure being available in most patients'
local areas. Patients are therefore presented with the
option to treat their scars at the Centre or when they
return home from their height increase procedure.
Since the development of the Ilizarov external fixator
frames in 1951 a number of other height increase methods
have arisen in smaller clinics in countries such as France
and Germany. The majority of these alternative methods
consist of inserting and securing internal lengthening
devices to the inner bone cavity. These procedures are
designed to reduce scarring to the patient's limbs and
provide more convenience during lengthening and fixation
however these methods are also accompanied by a number
of drawbacks. The most common devices include those of
Albizzia, Bliskunov and Fitbone and their practical application
is restricted exclusively to the femur. The option of
lengthening the tibia is not provided by internal methods
as the tibia's internal cavity is too small to accommodate
a functional lengthening device.
Internal devices, as they are situated within the patient's
bone, offer less stability and less control during the
lengthening process. Many difficulties occur during distraction
in regards to the performance and function of internal
devices and these cannot be rectified without the necessity
of additional surgery. These methods are therefore considered
to still exist within their experimental state due to
their low success rate with a number of patients having
been found to depend on crutches one to two years after
lengthening. This also accounts for the reason why internal
methods are not approved by the FDA.
A significant drawback to these alternative devices is
that corrections to the shape of the leg may not be performed
to assist in the aesthetic aspect of lengthening. Thus
distraction and lengthening can be achieved without improvements
to the shape and therefore functionality of the limb -
a factor which is not an issue with the Ilizaorv frame.
Another associated issue of internal devices is the development
of serious secondary complications (such as inadequate
lengthening of the surrounding soft tissue). This method
of lengthening performed on the femur poses a higher risk
due to its close proximity to the spinal column and cord.
Contraction often occurs in the backs of internal device
patients causing permanent damage to their stature. Therefore,
in all height increase cases it is primarily recommended
that lengthening be performed on the tibia as opposed
to the femur for security reasons as well as aesthetic
reasons. Additionally, as patients are considered more
independent with the internal apparatus, lengthening is
performed on an outpatient basis thus resulting in a higher
complication rate from lack of supervision and the appropriate
physical therapy pivotal to the success of any height
increase procedure. |
|
