Limb Reconstruction Treatment in Gurgaon
About Dr. Ratnav Ratan
Dr Ratnav Ratan is a consultant pediatric orthopedic surgeon in Gurgaon with key competence in performing limb reconstruction surgeries across all age groups. He has extensive experience in latest procedures of limb lengthening and bone transport, the use of internal and external fixators and intramedullary devices.
Limb reconstruction is a subspecialty of orthopedic surgery that focusses on acquiring maximum function from a deformed limb. The deformed condition of the limb could be an acquired one or due to a trauma or a congenital one. Limb reconstruction procedures are performed on both children as well as adults.
Limb reconstruction surgeries involve correction of nonunions, malunions, epiphysiodesis, joint reconstruction, rotational deformities, limb equalization and so on. At times, bone and soft tissue regeneration under conditions of distraction are undertaken depending upon the condition of the patient.
Deformity Correction Surgery
Deformity in bone relates to a bone which is not normal, i.e. either it is bent or twisted. The deformity could be due to congenital or due to trauma.
Congenital deformities include hemimelias, achondroplasia, club hand and clubfoot deformities, congenital pseudarthrosis. Acquired deformities occur on account of trauma, bone tumors, metabolic abnormalities and so on. Limb reconstruction techniques improve and correct these deformities to a great extent.
Deformity Correction Surgery is performed to straighten the bent or a twisted bone. The orthopedic surgeon will begin with an osteotomy procedure and create two bone segments of the bone.
The doctor will straighten and position the bone correctly followed by the insertion of an internal nail or rod or a metal plate device to ensure the bone rests in the corrected position for healing.
At times, the surgeon will perform soft tissue procedures for better outcomes. Also, an external fixator is applied for perfect alignment of the bone which is removed later on.
Infected nonunions occur when broken bones fail to heal, and infection persists at that site for 6 to 8 months despite undergoing best surgical or non-surgical treatment.
Regarding the infection state of the fracture, the surgeon may perform a surgical procedure to remove the pus and infected tissue along with a swab for further investigation.
Once the type of bacteria is identified, the surgeon will suggest antibiotic medication and treatment for the infection. The nonunion area is treated with special drains and antibiotic beads for rapid healing.
In such cases, the orthopedic surgeon will perform a bone graft surgery using the bone graft from the patient or an allograft. The surgeon will also try to stabilize the nonunion with an internal or an external fixator.
It is a challenge to treat and manage infected nonunions. It requires multidisciplinary management by a team of super specialists comprising of orthopedic surgeon, infection disease specialist, radiologist and plastic surgeon.
Limb lengthening surgery
Limb length refers to the difference in the length of the arms or the legs of a patient. The difference in length of the arms is referred to as upper extremity limb length discrepancy while that of the legs is referred to as lower extremity limb discrepancy.
In the earlier years of growth, the parents need to be observant about the extent of the difference. At times, non-surgical intervention can resolve the issue through physical therapy or by wearing a lift shoe (in case of legs) or wearing prosthetics.
Surgery for lower limb lengthening
The orthopedic surgeon will suggest a limb lengthening procedure if the patient displays a significant difference in the length of the legs. There are external as well as internal lengthening procedures.
External lengthening involves the bone of the shorter leg being cut into two segments and fixated with an external fixator. This empty space between two bones encourages the bone to regrow and fill up the space. The bone is likely grow up to 1 inch in a month provided the patient follows the prescribed guidelines meticulously. The external fixator could be either an Ilizarov frame or a hexapod frame.
In the internal lengthening procedure, the bone of the shorter leg is cut to implant an expandable metal rod in the bone. This metal rod increases its length as per the movement of the patient’s limb. Here too, the patient has to follow the doctor’s instruction carefully.
Shortening the lower limb in an adult involves the use of an intramedullary nail, especially of the thigh bone. In this procedure, the surgeon first removes a segment of the bone to shorten it and then fixes the bone with an intramedullary nail.
Surgery for upper limb lengthening
The orthopedic surgeon will suggest the best method and at what age to proceed with upper limb lengthening procedures. These procedures include –
- Stopping the growth of the longer upper limb
- Lengthening the shorter upper limb with an external fixator or an internal rod
- Shortening the longer upper limb through epiphysiodesis, a simple, minimally invasive procedure performed in growing children
- Reconstruction of the arm, wrist and hand to make them seem of equal length and well-aligned
- Skin grafts are also performed to improvise the surgically reconstructed area.
The patient will require extensive rehabilitation and physical therapy for a successful limb reconstruction procedure. It is essential to remember that the patient may need further medical guidance if the limb discrepancy is due to a medical syndrome or condition.
The orthopedic surgeon will suggest a hip replacement procedure if the patient experiences hip pain even when walking, getting in and out of the chair, while wearing socks and shoes, and is unable to rest properly.
The hip replacement surgery will replace the natural hip joint with an artificial hip joint consisting of two basic parts – the ball part and the socket part. The orthopedic surgeon will either press-fit these components into the bone to allow the bone to grow onto the components or cement them into place. These prosthetic components are made of plastic or ceramic or metal. The surgeon will decide the most suitable combination for the hip replacement surgery depending upon the patient’s condition.
Frequently asked questions
An external fixator is a device that is used to keep fractured bones in alignment and stable positions for healing. It is possible to adjust the device externally for better positioning. It is used to treat a bone infection or to rectify the position of the healed bone.
The external fixator frame could stay for a long duration of 4 – 6 months depending upon the condition of the treated fracture and the speed of recovery. After the initial period, the external fixator will not cause much pain or discomfort.
It is extremely essential to observe growing children for growth plate injuries, hip dysplasia, Perthes’ disease, Developmental coxa vara, Slipped Upper Femoral Epiphysis, Idiopathic scoliosis and so on that can be corrected in the initial stages for timely intervention and best outcomes.
At times, deformity in children can go unnoticed, leading to its progress well into the acquired stage for which limb reconstruction becomes essential. These conditions include achondroplasia – bone dysplasias, congenital tibial pseudarthrosis, congenital short femur, fibula hemimelia, and club foot, joint stiffness due to spina bifida or arthrogryposis.
Hence, it is advisable to observe and check the physical growth pattern of the children in depth.