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Limb Lengthening


For patients with uneven limbs, limb lengthening may be an option. However, treating this conditions properly, whether it’s due to injury or infection, requires orthopedic surgeons with unique experience.

J. Dean Cole, MD, the medical director at the Florida Hospital Orthopaedic Institute Orlando (FHOIO) is a pioneer in the field of orthopedic traumatology. In fact, he is the creator of the Intramedullary Skeletal Kinetic Distractor (ISKD), the leading treatment option for this condition. The ISKD has proven so popular and effective that it’s now the preferred procedure for limb lengthening worldwide.

Certain factors affect the duration and success of the Intramedullary Skeletal Kinesthetic Device (ISKD), including the desired length, the speed at which bone forms, and how effectively patients follow the recommended activities. Typically, J. Dean Cole, MD and his colleagues set a goal of extending the ISKD 1 millimeter each day. This process usually lasts for about one year, at which time additional ISKD devices can be implanted if necessary. 

There is a strict selection process, and not all patients qualify. Accepted candidates may have shorter limbs due to deformities or trauma; they may also be seeking cosmetic limb lengthening. Some patients may also suffer from back pain due to shortened limb lengths. Regardless, candidates should be ready to commit to the process, and must thoroughly understand this technique and its limitations.

Before any procedure is considered, J. Dean Cole, MD and his colleagues determine the specific lengthening goals. They use preliminary x-rays and take measurements of joint motion and body structure. These methods enable the lengthening device to be preset to the planned length, ensuring a successful healing process.

Performed under anesthesia, the ISKD procedure usually takes about two hours. First, an orthopedic surgeon implants a telescoping metal rod into the affected bone. After implantation, the surgeon splits the shortened bone in two (an “osteotomy”). In the newly created space, bone growth and healing develop gradually, until equal limb length is achieved. Soft tissue, including muscle and skin, forms as well.

After surgery, the uneven bones are pulled apart at a very slow rate until the new bones can support the patient’s weight. The gradual movement is done through regular limb movements. This entire process is internal, with no external fixation pins or wires. Once the desired bone growth is achieved, the ISKD device can be surgically removed.

To ensure and maintain patients’ rates of new bone growth, long-term, personalized physical movement programs are prescribed. These movements, typically foot, knee, ankle or leg rotations, cause the telescoping rods to gradually extend new bones. Patients should take measurements at least five times each day, though this growth can be monitored at any time, especially following physical activity.

This exertion, which often involves the participation of others, can include normal activities, controlled movements and partial weight-bearing exercises. Once the ISKD is implanted, it’s vital that patients strictly follow their specific program schedules. These movements are very safe, and following surgery, patients receive handheld magnetic sensors. Along with monitoring daily bone growth, these sensors greatly reduce the risk of accidentally over-stretching the newly formed bones.

As the ISKD device works completely internally, and has no external fixation pins or wires, the risks of potential infection and scarring are dramatically lower compared to the traditional external device. This procedure jumpstarts the volume of the surrounding soft tissue, boosting both stability and alignment.

J. Dean Cole, MD and his colleagues have implanted the ISKD device in more than 100 patients. The ISKD has proven so successful that this procedure is now performed by trained orthopedic surgeons throughout the United States and Europe.

Limb-lengthening procedures may offer valuable benefits for patients with cosmetic concerns. For instance, some individuals with shorter legs may want to become taller, while others may have two legs with different lengths. Others still may suffer from premature puberty. For these cases, cosmetic limb-lengthening surgery may be considered stature enhancement that has functional indications.

J. Dean Cole, MD has had great success in limb-lengthening surgery for all patients, whether this surgery is for medical or cosmetic reasons. J. Dean Cole, MD’s own invention, the Intramedullary Skeletal Kinetic Distractor (ISKD), is particularly effective for cosmetic procedures. As the procedure is internal, patients can use wheelchairs, walkers or crutches during lengthening. And unlike external fixators, the ISKD leaves patients with minimal, discrete scarring that fades over time. 

At the Florida Hospital Orthopaedic Institute Orlando, the typical cosmetic leg-length discrepancy treatment is completed within 45 days. The healing process usually takes two to three months, and most patients can return to their normal level of activity within six months. Patients are required to perform regular stretching exercises before, during and after lengthening.

As with other surgical procedures, not everybody will qualify for cosmetic limb lengthening. All age groups—once patients have completed their normal growth, usually around the age of 15 and older—can undergo these procedures. These older cohorts also tend to have a better understanding of the procedure.

Surgeons and medical professionals emphasize that cosmetic lengthening is only for stature enhancement. As such, those with body dysmorphic disorder should not consider this procedure, as additional lengthening (or shortening) surgeries may be requested.

Lengthening does not occur automatically, so patients must have clear goals. This is a lengthy process, requiring significant investments of money, time and effort. Therefore, they must be thoroughly educated about the involved surgical techniques and mechanisms. They must also be aware of the potential risks and complications before undergoing surgery.

It’s also important to point out that insurance companies do not cover the cost of cosmetic procedures such as limb lengthening, so patients must cover the total cost.

Today, patients desiring limb lengthening in Orlando and beyond turn to the Fracture Care Center—and specifically, J. Dean Cole, MD’s groundbreaking ISKD device. For information visit the Florida Hospital Orthopaedic Institute Orlando website, or contact us to schedule an appointment.