Bone lengthening not recommended by doctors

New Delhi: Gavriil Abramovich Ilizarov, who used external devices on patients to fix infected non-unions of bones in the 1950s, might not be a well-known orthopedic surgeon but his technique gained some popularity among Indians.

Indians, in recent past, preferred Ilizarov technique to increase their heights.

Ilizarov surgery has been accepted globally for lengthening the bones up to four to six inches but doctors advise not to go through this extremely slow and painful procedure for cosmetic purpose.

Femur (thigh bone) and tibia (lower leg bone) are the two bones that are involved in the elongation purposes.

It takes, at least, four to six months before this painful process is complete.

In layman terms, the surgery involves strategically breaking the bone and then slowly separating the ends of the broken bone over a long period of time to gain extra height. This is done under the supervision of highly trained surgeons only, experts advise.

"It works on the principle of distraction osteogenesis, whereby slow and controlled distraction of bone at 1 mm per day generates new bone at the lengthening site of a bone. This is done using an external ring fixator or frame," said Dr (prof) Raju Vaishya, senior joint replacement surgeon at Indraprastha Apollo Hospitals and president of the Arthritis Care Foundation.

"Ilizarov surgery is a boon for patients with severe compound fractures, for the lengthening of bones and for deformity correction of bones and joints," said Dr Vaishya.

Dr Dhananjay Gupta, senior consultant (orthopaedics) at Fortis Flt Lt Rajan Dhall Hospital in the capital did not recommend the use of this technique for cosmetic purpose.

"As the body tries to heal the break by creating new bone, the fracture is extended yet again and the body creates even more, bone in the gap during the process," added Subhash Shalya who is associated with Delhi-based Orthopedic Surgeon Bone Joint Care Foundation of India.

During this agonizing process, the fracture is extended by a tiny amount several times a day, up to a millimeter each day, until the desired length is reached.

"The trick is to do it slow enough so that new bone continues to grow, but fast enough that it does not heal entirely," Shalya added.

Doctors, nowadays, use fixators, which have rings, rods, and wires to gradually distract the bone parts and keep them fixed at desired length.

"The entire procedure is minimally invasive as it uses wires to fix the bones to the rings. It involves less tissue damage and ensures a quick recovery. After the procedure, the Ilizarov fixator is removed," said Shalya.

The procedure is followed by a lengthy rehabilitation period and extensive physiotherapy to allow the body to get accustomed to the new bone development.

"Wires which are passing through soft tissue and bone may get infected and painful. Regular distraction should be done with clock-like precision as too fast or slow rate may jeopardise the outcome," advised Dr Gupta.

"Blood vessels or nerve may not stretch at the same rate and may result in loss of their function. Muscles may cause stiff joints; so this procedure must be done under the guidance of a very trained surgeon," he said.

According to Dr Sanjay Agarwala, head (orthopedics and traumatology) at Mumbai-based P.D. Hinduja National Hospital & Medical Research Centre, as in any operation, there are concurrent risks which are manageable.

"As it is a slow process, it needs perseverance and persistence both on the patient and doctors' part. The procedure has been in place for 30 years and fills a required niche in orthopedics," said Dr Agarwala. (IANS)