2. Techniques for lengthening Prof Dr Khaled Emara Ain Shams University Cairo, Egypt

3. UPPER END LOWER END SHAFT

4. The lengthening site The first step in lengthening is we the - Orthopaedic surgeon- make a surgical cut in the bone by a special technique This cut act as a growth center for the bone The direction of growth & stability of the bone till we finish lengthening is controlled by several fixation devices & techniques

5. osteotomy site

6. Internal & external fixation

10. Techniques of fixation & lengthening Pure external fixation (old classic ) External fixation for lengthening over a nail External fixation & lengthening then early removal & replacement by a nail once lengthening is finished Internal lengthening nails with out external fixation

13. External fixation It is an old technique have been used for a very long time It is effective & safe But it is uncomfortable for the patient as the external fixation stay for a long time in the leg (about one month for every centimeter lengthening) Need close follow-up & care by the patient & the doctor

15. Frame

17. Gradual: uniplanar VS. circular X FX

20. Risk of infection at the pins of the external fixation or soft tissue irritation is the most common problem (usually a minor problem) controlled by frequent cleaning & antibiotics The patient discomfort due to the bulky device which can limit the activities during lengthening Need regular cleaning of the pins & physical therapy for the muscles & soft tissues It give better control over the lengthening & soft tissues as the muscles & nerves

28. Internal lengthening devices More comfortable fro the patient as the lengthening device is inside the bone not out side the leg But less control on the device as it can go faster or slower than required for lengthening, this can cause new bone callus problems as premature healing of the lengthening center in the bone before finishing lengthening

29. Also it can cause too rapid lengthening with much stress on the muscles & joints & nerves & this can be harmful to the function after lengthening Nail jamming or mechanical problems that can happen during lengthening The control over that device is not as good as the external fixation device More expensive

33. Lengthening over nail This can be used to put a nail inside the bone & lengthen the bone by external fixation device till finish lengthening then we remove the external fixation & fix the nail finally at the new bone length so we dont need to keep the external fixation device till full maturation of the new bone

34. This technique give shorter duration of external fixation (1/3 the pure external fixation technique) This give more comfort to the patient & earlier rehabilitation & regain of muscle power & joint range of movement There is higher risk of deep bone infection than other techniques

39. Lengthening then nailing Remove the external fixation device once we finish lengthening & replace by a nail at the new length This technique has the same advantage of lengthening over nail but with much less risk of infection & more patient comfort We recommend this technique as it is safe & effective

51. Thanks Dr Khaled Emara 13 B Kornesh EL Nile, Agha Khan, Cairo, Egypt Tel: (202) 2055661, (202) 2055664 Tel: (2012) 2513929 Fax: (202) 2055662 Email: kmemara@hotmail.comkmemara@hotmail.com Web site: www.khaledemara.comwww.khaledemara.com