Implants Shorten Time For Bone-Stretching Procedure

BALTIMORE -- New implants are allowing leg bones to be lengthened more quickly without external braces and pins that extend into the bone.

Hundreds of surgeons from around the world are in Baltimore for a weeklong limb deformity course sponsored by Sinai Hospital's Rubin Institute for Advanced Orthopedics, learning, among other things, about the rod-like inserts.

"It doesn't interfere with your life as much ... you don't have an annoying device on the outside to contend with," said Dr. Dror Paley, one of the directors of the course.

While such devices can be used to make short people taller, they are most often used to help repair deformities, either from accidents or birth defects, surgeons at the conference said.

"We're excited about it because we see tons of trauma," said Dr. Frederick Wilson, an orthopedic surgeon at the East Texas Medical Center in Tyler, Texas. "Car accidents, industrial accidents, falls from height, agriculture. I'm excited about the ability to get people back to functional status quicker."

A lengthy recovery period can lead to unemployment, drinking, depression, divorce and other problems, Wilson said.

"Something that gives them a chance to get back to a functioning level quicker would be a tremendous help," he said.

The International Center for Limb Lengthening at Sinai Hospital has conducted about 7,500 lengthenings since 1987 and is the most experienced in the world in the procedure, said Paley, one of the clinic's founders.

Of the about 150 lengthenings conducted with the new implantable devices, approved about 2 1/2 years ago, the center has conducted more than half, Paley said.

"It's a big time saver, it's really the wave of the future," Paley said. "It's a little more expensive, but we may make that up because of less complications."

For example, a 5 cm, or 2 inch, lengthening using external brackets would take about six months for an older child while it would take less than three months with the implantable lengthener, Paley said.

After the shaft is inserted into the hollow center of a leg bone, which is cut into two pieces, the patient must move the leg daily to allow the insert to expand. The most common problem with the implants is the bone either stretches too slowly or too fast, which occurs about in about 30 percent of cases, Paley said.

The device works best for small lengthenings, so surgeons tend to limit its use to 5 centimeters. If more lengthening is needed, the procedure can be repeated, Paley said.

Dr. Chris Whately of the Dubai Bone and Joint Center said many of the lengthening cases he sees are the result of trauma or deformities that have left the patient hobbled with one leg shorter than the other.

Lengthening dramatically improves the quality of life for many patients, but surgeons often refuse to take the cases because of the possibility of complications.

Those patients, however, are "some of the happiest patients you have," he said. "They are grateful, even if there are complications."

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