External vs. Internal Fixation: Height Increase Surgery

Leg length discrepancies can arise due to various reasons, affecting gait, posture, and causing pain. Fortunately, advancements in orthopedic surgery offer solutions to address these concerns. Two primary approaches for leg lengthening are External vs. Internal fixation. Let’s delve into each method to help you understand which might be the best fit for your needs.

Understanding Leg Length Discrepancy

A leg length discrepancy occurs when one leg is shorter than the other. This difference can be minor (a few centimeters) or significant, impacting daily life. Common causes include:

1. Congenital conditions: Birth defects that affect bone growth can lead to leg length discrepancies.
2. Fractures: Improperly healed fractures can cause shortening of the bone.
3. Infections: Bone infections can damage growth plates, leading to discrepancies.
4. Bone tumors: Treatment for bone tumors may sometimes involve removal of bone, resulting in a shorter leg.

Limb Lengthening(External fixation) : A Gradual Approach

Limb lengthening is a surgical procedure designed to gradually increase the length of a shorter leg. Here’s a breakdown of the process:

1. Osteotomy: The surgeon cuts the bone to be lengthened.
2. Fixation Device: An external fixator (a metal frame with pins attached to the bone) or an internal lengthening device (a rod implanted inside the bone) is used to stabilize the separated bone segments.
3. Distraction Phase: Over a period of weeks or months, the fixation device is gradually adjusted, slowly separating the bone ends. This stimulates the body to produce new bone tissue within the gap, effectively lengthening the bone.
4. Consolidation Phase: Once the desired length is achieved, the bone is allowed to heal and solidify. The fixation device is then removed.

Benefits of Limb Lengthening(External Fixation):

1. Significant Length Correction: Limb lengthening can address larger leg discrepancies compared to internal fixation techniques.
2. Improved Function: Corrected leg length can improve gait, reduce pain, and enhance overall mobility.
3. Cosmetic Improvement: For some individuals, limb lengthening can offer a cosmetic benefit by achieving leg symmetry.

Challenges of Limb Lengthening(External Fixation):

1. Lengthy Process: The procedure can take several months, requiring patience and commitment to physical therapy.
2. Potential Complications: Like any surgery, there are risks of infection, pin site problems, and stiffness in the joints.
3. Psychological Impact: The extended recovery period can be mentally demanding.

Internal Fixation: A One-Time Surgery

Internal fixation is a surgical procedure where the discrepancy is corrected in a single operation. Here’s how it works:

1. Bone Shortening (if needed): In some cases, the longer leg might be shortened to match the shorter one.
2. Bone Cutting and Realignment: The shorter bone is cut, lengthened (using bone grafts if necessary), and fixed in the correct position with plates, screws, or nails.

Benefits of Internal Fixation:

1. Faster Recovery: The recovery time is generally shorter compared to limb lengthening.
2. Less Visible Scarring: Since there’s no external fixator, scarring is typically less noticeable.
3. Potentially Fewer Complications: With just one surgery, there’s a lower risk of complications associated with external fixators.

Challenges of Internal Fixation:

1. Limited Length Correction: Internal fixation may not be suitable for large leg discrepancies.
2. Stress on the Bone: The newly fixed bone may experience stress during healing, requiring careful monitoring and activity restrictions.
3. Potential for Refracture: There’s a small risk of the bone refracturing at the fixation site.

Choosing Between External Fixation and Internal Fixation

The decision between limb lengthening and internal fixation depends on several factors:

1. Severity of Leg Discrepancy: For larger discrepancies, limb lengthening might be the only option.
2. Age and Overall Health: Younger patients generally tolerate limb lengthening better.
3. Activity Level and Lifestyle: The lengthy recovery of limb lengthening might not be suitable for highly active individuals.
4. Desired Outcome: Cosmetic considerations might favor internal fixation with less visible scarring.

Consulting a Qualified Surgeon

An orthopedic surgeon specializing in limb lengthening and deformity correction is crucial for a proper evaluation and personalized treatment plan. They will assess your specific situation, discuss the risks and benefits of each approach, and help you make an informed decision.

Conclusion

Both External vs. Internal fixation offer effective solutions for leg length discrepancies. Understanding the advantages and limitations of each method, along with guidance from a qualified surgeon, will empower you to choose the treatment that best aligns with your medical needs and personal goals.