Leg lengthening and deformity correction using Ilizarov fixator and LRS systemIlizarov procedure and apparatus was discovered by Prof Gavril Abramovich Ilizarov in 1950s. This technique has revolutionized treatment of difficult orthopedic problems and is used to lengthen or reshape bones; to treat complex fractures with open wounds and bone loss; infected non unions and to correct deformities of joints. Bone lengthening and deformity correction works on principle of distraction osteogenesis. For lengthening, bone is surgically fractured by keeping its covering, periosteum intact (Corticotomy) and Ilizarov apparatus applied. Bone lengthening occurs if rings are made to move apart slowly 1mm per day at the site of surgically created fracture. Lengthening distraction is started approximately 7 to 10 days after surgery in adults. In children it is started at about 5 days.
Candidates for limb lengthening or deformity correction by Ilizarov procedureAnyone with leg length discrepancy (short leg), congenital limb and joint anomalies, nonunion, malunions, bone loss, joint contractures, osteomyelitis or severely comminuted fractures with extensive soft tissue involvement can undergo this procedure. Lengthening of 5 to 7 cms will require 5.5 to 6.5 months. Intensive physiotherapy program will be done during lengthening and after frame removal.
RehabilitationPatients are allowed to walk with walker or crutches the next day after surgery. This helps in early rehabilitation of patients. Physiotherapy and rehabilitation program is very important for proper functioning of joints, to prevent contractures and muscles to gain normal strength. Various modalities like active and passive stretching of muscles, static and dynamic splinting, electrical stimulation, hydrotherapy, progressive weight bearing, etc are employed.
Possible complications of the procedureAny surgical procedure has its complication. With due care and experience of surgeon these complications can be minimized to negligible. The most common one being pin/wire tract infection, loosening and breakage. Delayed maturation of regenerate or deformity or nonunion at docking site are possible complications. Prolonged fixation and non adequate physiotherapy can lead to stiffness of joints. Smoking can delay maturation of regenerate and may require fixator to be kept for longer duration. Rarely damage to nerves and blood vessel can occur. Complications are temporary and do not influence the final outcome usually.
Achilles tendon lengtheningThe gastrocnemius calf muscles begin slightly above the knee. The soleus calf muscle begins in the calf. Together they form the Achilles tendon which attaches at the heel. The function of the Achilles tendon is to lift the heel off the ground and flex the foot. Problems with walking and standing occur when the muscles in the front of the leg are not strong enough to pull against the Achilles tendon, making it impossible to stand upright with the heel on the ground. The Achilles tendon contracts thereby forcing the foot into a downward pointing position. Achilles lengthening is done to allow the foot to be positioned at 90 degrees to the leg.
CausesCerebral palsy is on of the most common causes of Achilles contractures. Approximately two to four children of every 1,000 are affected by cerebral palsy. Spina bifida, clubfoot and other congenital diseases can result in foot deformities requiring Achilles lengthening. Mid-foot amputation, spinal cord injury and stroke are also conditions that can change an adult's muscle balance in the leg leading to the foot being flexed downward.
SurgeryThere are four commonly used surgical procedures to lengthen the Achilles. The percutaneous method makes several small cuts in the tendon using stab wounds through the skin. The cut edges move apart, lengthening the tendon. A gastroc recession uses an incision in the calf to release the deep gastrocnemius muscle. Some doctors prefer doing open surgery with a Z-plasty technique. The tendon is cut halfway across then the tendon is split up the middle for several inches. A final cut is made on the opposite side of the tendon. The tendon is made longer by moving two halves of the tendon apart then sewing the overlapping sections back together. In some conditions such as spinal cord injury or spina
bifada, the tendon may be completely cut. This eliminates the ability of the Achilles to flex the foot downward.