FAQS

I have a short stature, I am healthy. Can I increase my height with lengthening?

Am I a candidate for bone lengthening or deformity correction?

What is the care of the external fixator and pins?

Physical therapy  is essential to obtain good results during treatment, a routine should be carried out daily for several hours (2 to 3 hours a day, divided into 45-minute sessions), in several sessions in the morning before bathing, at noon and late afternoon, for a total of approximately 3 hours;  Therapy should not be limited to the one directed by the therapist 3 times a week, and it is necessary to develop an assisted, personal and continuous program for each case, to develop a series of repetitive exercises to maintain the muscle tone and joint mobility necessary for walking and activities after treatment. A good physical condition must be maintained not only to strengthen the limb, but to promote mobility and avoid rest diseases (venous thrombosis, pneumonia, rest ulcers, cramps, muscle and joint contractures, loss of muscle mass, edema) and general physical deconditioning. This therapy at home must be assisted by the family and in the case of children by their parents. Active and continuous participation of family members in this complex and sometimes painful treatment is very important.

In most cases, the patient can support and move freely with the external device, alone or with the help of crutches or a walker, the amount of support allowed is determined on a case by case with the specialist. Exercise and daily therapy are essential to obtain a optimal outcome that allows adequate joint mobility and avoids contractures or muscle stiffness.

Overall, in bone elongation or transport cases where the distraction osteogenesis method is performed, treatment time is approximmatley 1.5 to 2 months per centimeter of callotasis or bone distraction. There is an 8–14-day post-operative latency period before 1mm daily lengthening of bone growth is initiated, which varies depending on the age of the patient. For example, if the elongation required is 10 cm, treatment period would be 100 days + latency period of 14 days. This would be the first stage of the treatment. Once distraction is completed, there is another latency period to allow the new bone to mature and ossify, which can take twice as long as the distraction period. In the classic technique that uses only the external tutor for the entire treatment, an elongation or transport of 10 cm lasts between 15 to 20 months.

Currently, a technique developed by Doctor León Mora is being applied, which consists of removing the external fixator and placing a special plate to support the new bone; The technique which consists of an early replacement of the external fixator to an LCP plate system, decreases the time of use of the external fixator approxiamtely 8 months, favoring rehabilitation and improving patient comfort and quality of life during therecovery process. 

The procedure consists in the removal of the external tutor and the installment of an internal fixation system, LCP plate. This procedure should be performed between 20 to 30 days after the limb lengthening) or bone transport is completed, this allows stabilization of the immature bone of the callotasis, more comfortable joint mobility, avoids discomfort and the risk of infection associated with pins that pierce the skin, muscle, and fascia for long periods of time.

This technique described and applied by Doctor Mora allows early rehabilitation and decreases the use of the external tutor approximately 8 months when compared with traditional methods. It is an advanced and complex technique that requires the application of a safe protocol to avoid complications such as malalignment, infection, and failure of the osteosynthesis material.

In most cases, the patient must move almost immediately after the surgery. External fixators are devices that are attached to the bone and are stable and safe enough to allow full mobility of the limb, even complete support without the existence of risk of rupture or damage in surgery. However, after each procedure patients must discuss with the surgeon and with the physical therapist how much they can move their limbs, how much support is allowed with the tutor, and whether they use crutches or a walker.

Patients with the external fixator must move joints and muscles of all the extremities, and should not remain on absolute bed rest, as this could lead to muscular atrophy, physical deconditioning, stiffness and joint contractures; additionally stillness facilitates venous ecstasy and atrophy of muscle movement which is the pump that pushes accumulated blood from the legs towards the heart, preventing the appearance of venous thrombosis, a serious and dangerous complication that can be avoided with adequate and permanent physical exercise.

Physical therapy is not limited to the personalized sessions with the therapist or during hospitalization. A personalized daily individual home program must also be established with the specialist and physical therapist to determine what movements should be performed and how to strengthen muscles and maintain active circulation, that consists of 3 hours, distributed in 1-hour sessions, to maintain an adequate muscle response, functional joint mobility and avoid late complications due to excessive bed rest and lack of therapy.

If you have intense pain, feel mobility of  bone segments, or perceive instability of the external tutor, it is important to consult with your specialist immediately to assess the situation and define how to solve the abnormal event.

The fundamental goal for patients during this phase of treatment is to maintain the maximum range of joint movement possible and preserve the muscle strength and mass that they had prior to treatment. This can only be achieved with the commitment of the patient and their family, to perform persistent daily physical activity at home.  Treatment can cause discomfort and pain, but it can increase exponentially when no rehabilitation activity or movements are carried out at home.

Most exercises are simple, do not require special equipment and only need a positive and persistent attitude to achieve the goal of maximum mobility and less pain!

For more information, you can view a series of exercises in the educational videos offered by the Limb Lengthening and Bone Reconstruction Clinic.

If you notice that skin surrounding the pins presents secretion or redness, you should immediately start improving care by cleaning the pin properly with saline solution or tap water twice a day with a sterile gauze or a clean moist swab, taking care not to use the same swab or gauze to clean other pins, to avoid contaminating other pins and cause an infection on another site. If an antibiotic has been prescribed by your doctor, you should begin taking it immediately and closely monitor tissue behavior and improvement. If you notice that it does not improve within a period of 3 days, you should request an immediate evaluation or consultation with your specialist. If you have severe pain severe, you should consult the emergency room at a hospital authorized by your insurance.

Normally in the thigh area, there is drainage of light-yellow fluid around the pins, which is normal due to the muscle mass that the pins pass through. A sterile gauze dressing should be placed daily on those pins that have this secretion and monitor changes such as increased fluid secretion or redness around the pins.

The surgery is performed in recognized hospitals that are internationally certified to perform   this type of highly complex treatment and comply with all international safety and technology standards.  The treatment plan and costs include, lodging, food, nursing care, personalized physical therapy sessions and everything related post-surgical care. Patients must plan and are required to stay in Medellín during a 3-month period, after which they may return home and will be followed and monitored on-line during another 3-month period.

As any surgical procedure, complications may occur, but the most important thing is to avoid preventable ones and that the patient be supervised by a group of experts in bone lengthening to detect and treat any adverse situation early. The most common situations that may occur are muscle contractures due to lack of physical therapy, delayed bone maturation and pain and discomfort due to inadequate pharmacological management and analgesia. Overall, if lengthening is managed efficiently and carefully, the percentage of complications is very low.

In general, bone elongation devices are expensive due to the highly sophisticated and advanced technology used such as that of intramedullary Precice® Nail.  The cost of each nail is approximately US$18,000. External tutors vary in cost depending on their origin and quality. Additionally, hospitalization, a 3- month physical therapy plan and medical team fees must also be covered. Costs vary depending on the city and location of the hospital and medical fees where it is performed. In the US there are centers where comprehensive treatment exceeds US $200,000 US with an average of US$120,000. In Europe the average is US$100,000 euros. In Medellín-Colombia with the Cora Group, the complete treatment ranges between US$ 30,000 and 60,000 dollars depending on the device used.  Most importantly however when taking the decision where to carry out the procedure, is to consider the experience and expertise of the rehabilitation team, which in our case is backed by more than 20 years of experience in bone lengthening treatments.

It is very important to be convinced of the treatment, to be properly informed about the center that offers the lengthening procedure, and the experience of the specialist. Full time commitment and  dedication to physical therapy and care during post-surgical lengthening process,  activities that involve walking or distance movements are not recommended during this period, a personalized and face-to-face consultation should always be carried out before undergoing surgery for to perform a thorough clinical exam and analysis of the limb to be lengthened, as well as to personally answer, explain clarify specific doubts  with the patient and his family , given that  highly specialized and complex nature of the treatment.

We are a center specialized in reconstructive surgery and bone lengthening, that offers more than 20 years of experience, state of the art technology and that is highly recognized worldwide.

We hope this information will be useful to you in your quest to increase your height or if you require any type of bone lengthening procedure.

Occasionally during the bone lengthening or distraction period, patients may present intense pain, a burning sensation on the skin, or deep pain, especially at night or with low temperatures. In this situation it is important to remain calm, take the medication prescribed by the specialist, and if symptoms persist, contact the Lengthening Clinic to reinforce pain control therapy.

You should not place substances or plasters over the elongated limb, nor should you place hot cloths in the area, as this can increase inflammation and pain and can cause skin burns, worsening the situation.

If the pain is intense despite rest and analgesics, the patient can stop the distraction for a period of 3-5 days and then restart it; this will reduce painful crisis and possibly allow the lengthening to continue. If it is not possible to restart it,   an URGENT and immediate consult should be made at the Lengthening Clinic to evaluate the situation, because if the lengthening system is left without movement for a period of more than 3 weeks, bone may consolidate and prevent further lengthening, especially in children, given their faster healing processes.

If severe edema, intense acute pain, or a sensation of a severe cold of the extremity is observed, the patient may be presenting a deep venous thrombosis, and therefore must consult URGENTLY and immediately the emergency room of their hospital.

There is existing legislation regarding the rights of patients contemplated by law.  In the enclosed annex, the most important parts on the rights to comprehensive, complete, and timely care in specialized high-tech centers are underlined (LAW 1122 OF 2007 and BILL 210 of 2013 issued the Colombian Senate).

In the PDF Annex you will find the most important aspects and articles that protect patients and their access to reconstructive limb surgery services in Colombian legislation.

Law 1122 of 2007

Bill of Law 210 de 2013

Is it necessary to wait until growth is complete to perform a limb lengthening or correct a deformity?

This is not true, many specialists due to ignorance or negligence tell patients that they must wait until the end of adolescent growth to correct discrepancies or deformities and delay timely treatment of these cases.

Early diagnosis of deformities or diseases that cause length discrepancy can be made, even since pregnancy, that will require the intervention of specialized groups in limb lengthening and reconstruction of deformities. Currently, it is possible to perform serial lengthenings and early bone corrections during childhood that avoids major problems in adolescence or as adults. Unfortunately, many families consult late due to lack of information about these surgeries which be performed as early as 2 years of age.

If you or one of your children presents a difference in length or a deformity, you should consult a specialized center to receive guidance and information on treatment alternatives and surgeries that must be scheduled to solve the problem in time, avoiding late irreparable complications such as joint damage, inveterate dislocations or lack of muscle development, which can lead to irreparable injuries or limitations greater that can be prevented if an EARLY and adequate treatment is carried out.

When a reconstruction is planned from an early age, it can be performed in stages, having less impact on the development of the child, a better functional recovery, and avoid problems that occur when surgery is performed on adolescents or older adults when treatment is more complex and causes a greater impact on the patient.

Many patients, due to fear or pain, do not perform any type of cleaning of the skin and of the extremity that is undergoing limb lengthening, which leads to the accumulation of dead cells, loss of normal skin lubrication and favors the appearance of cracks or accumulation of dirt and blood residue, tissue and cells, in addition to the fact that nails are not cut; All of this generates a dry and dirty aspect of the extremity that causes rejection, depression and isolation of the person undergoing treatment.

All this must be avoided from the beginning of treatment, complying with daily care of the pins, removing the dry scabs around the pins, adequately cleaning the external fixator, performing an adequate, sufficient and complete bath of the extremity every 4 days with tap water and neutral pH soap, using a soft sponge to remove all accumulated residue.

If the skin is a bit dry, moisturizing cream can be applied, ensuring that it does not accumulate at the interface between the pin with the skin. It is also advisable in some cases to apply water-soluble zinc oxide cream to protect delicate or dry skin and avoid its excoriation.

Nails require very special care and should be kept lubricated and clean. They should be trimmed straight every two weeks, taking care not to without cause inflammation of the fingers due to the risk of local infection. A small amount of mineral oil can be applied if they are very dry or dehydrated.