Orthopedic Services

Limb Lengthening Success Stories, Jason Stoneback, MD

Limb Deformity Correction

• Bones can have an abnormal alignment or deformity for a variety of reasons, including congenital differences, trauma, and prior surgeries.    The affected bone(s) may be rotated or angled in such a way that causes changes in gait while walking, pain, or visible differences.
• Treatment options
• Correction involves an osteotomy procedure in which the surgeon cuts the affected bone and straightens the segments.  The surgeon may use an internal stabilization device, such as a rod, to hold the bone in place while the segments heal back together.
• Alternatively, the surgeon may elect to use an external fixator to make gradual adjustments to the bone over a period of weeks or months, depending on the amount of correction needed.  The external fixator remains in place until the bone is straightened and heals back together.
• Risks
• Like any surgery, there is a risk of post-operative complications like pain, swelling, and infection. There is also a risk of delayed bone healing after surgery.  The Limb Restoration team at UCHealth mitigates these risks by utilizing a comprehensive interdisciplinary team to ensure patients are extensively evaluated and optimized before, during, and after the procedure.
• Recovery and Outcomes
• Following surgery, the bone will need time to heal.  This may take X months, depending on the amount of deformity correction required.  During this time, the patient may be restricted to a limited weight-bearing status.  Once the bone is healed, the patient can resume normal activities, generally with less pain than prior to surgery.

Nonunion and Malunions Fractures

• When a bone does not heal as expected after a surgery or traumatic fracture, it can be considered a delayed union or a nonunion fracture.  When a bone heals out of normal alignment, it is called a malunion fracture.
• Treatment options
• Nonunion repairs generally involve several steps.  The surgeon will rule out or treat any suspected infections.  The surgeon will then attempt to re-stabilize the fracture utilizing
• internal fixation with rods, plates, screws, and bone grafting materials
• External fixation with a circular ring fixator
• Malunion treatment is similar to nonunion repair, although, since the bone has healed, the surgeon will have to perform an osteotomy to separate the bone segments before resetting the fracture.  Techniques are detailed in the deformity correction section (Link)
• Causes
• Infection, inadequate stabilization, lack of blood flow, metabolic factors, and lifestyle factors
• Significance
• Left untreated, nonunion and malunion fractures can lead to pain, instability, increasing deformity, and limitations in daily activities.

Osseointegration Surgery in Amputees/ Bone-Anchored Limb

Osseointegration surgery involves the insertion of a metal implant in the remaining bone of an amputated limb.  This metal implant has an external component that allows the use of a prosthetic limb without a socket.

• Significance
• Osseointegration surgery can be life-changing for people who struggle with socket prostheses.  It can eliminate the issues associated with sockets, such as wounds, sweating, and poor fit.  It is especially helpful for people with skin grafts or short or unusually shaped residual limbs.  It may also allow for the return of some sensory function of the limb. 

• Treatment Options
• Osseointegrated implants can be used for the upper and lower arms and the upper and lower legs. A variety of implants may be used depending on the clinical situation. The treatment duration and course are dependent on the type of implant that is used.
• Dr. Stoneback’s Expertise
• Dr. Stoneback has expertise with screw fit and press-fit implants, and certain investigational implants.

Limb Lengthening

Most people have a slight difference in the length of their right and left limbs.  Excessive limb length differences can occur as a result of injury, infection, prior surgery, or conditions present at birth.  Limbs may also be lengthened for cosmetic reasons.

• Significance
• Left untreated, limb length differences can cause changes in the body's biomechanics.  This may lead to progressive pain, limitations in activities, and degenerative changes in nearby joints. 

• Treatment Options
• Significant limb length differences can be treated utilizing conservative measures such as orthotics (e.g., shoe inserts) or through surgery.  Surgery may involve hardware placed inside the bone or hardware placed on the outside of

Complex Fractures

• Significance
  • Complex fractures are challenging to repair and carry a higher risk of limb loss. They often require several surgeries over weeks, months or even years.
• Treatment options
  • Treatments are tailored to the situation, and may include custom or specialty implants and devices to grow bone, fix fractures, and treat infections. Other specialists may need to be involved to close large wounds or to restore blood flow and maximize healing potential.

• The Limb Restoration program enlists the expertise of various specialists to treat limb-threatening conditions, such as crush injuries, traumatic injuries, vascular disease, diabetes, and infections, with a goal to perform limb-sparing surgery whenever feasible.

• Patients may require the assistance of the following specialists in complex reconstructions:
• Orthopedic surgeon - surgically removes infected bone and tissue, stabilizes fractures, grows or grafts new bone, and corrects deformities
• Plastic and reconstructive surgeon - grafts skin and muscle when complex wound closure is needed, performs microvascular surgery to restore sensory and nerve function to the affected area.
• Interventional Radiologist - assesses blood flow to the affected limb and determines if any minimally invasive interventions will improve flow.
• Musculoskeletal Radiologist - provides extensive interpretation of imaging studies to help guide surgical and medical treatments, and performs injections and sampling of bone to help identify sources of pain or infection.
• Vascular surgeon - treats conditions requiring open correction of reduced blood flow, such as bypass grafts.
• Infectious disease provider - treats infections and monitors response to treatment, and makes recommendations to surgical providers for ongoing care.
• Wound care provider - provides advanced treatment of wounds to augment healing.
• Nutrition specialists assess ways to improve healing through dietary and supplement intake.
• Endocrinology provider - assesses for and treats factors that affect bone density and healing, such as vitamin deficiencies, glucose control in diabetes, and bony remodeling.
• Physical Medicine and Rehabilitation provider - assesses for ways to maximize patients’ independence in activities of daily living and improve quality of life.
• Pain management - helps to treat pain associated with complex conditions.
• Social work - assesses for socioeconomic barriers to recovery, including financial challenges, transportation, safe housing, and access to healthy food.