For Robert Rosser, two-inch lifts in his left shoe were part of his life for 30 years. A childhood bone infection interfered with the normal growth of his leg -- making every step hurt.
"It was a sharp, sort of stabbing pain in my left ankle, primarily in my left ankle and left knee," he says.
An implant -- called an Intramedullary Skeletal Kinetic Distractor -- or I-S-K-D -- changed everything.
Emory Orthopedic Surgeon, Dr. Robert Bruce says unlike external devices traditionally used to increase bone length, this device works from the inside -- stimulated by the patient's own movement.
"It's a ratcheting mechanism. It's a one-way ratcheting mechanism, and by walking and by moving, the cyclical motion of the extremity deploys that racheting mechanism," says Dr. Bruce.
Day by day, and millimeter by millimeter, a monitor helped rosser measure Rosser's progress. His left leg gradually lengthened about two inches to catch up with his right.
After his surgery, Robert's walking a couple miles a day and even finished his first 10k -- doing things he never imagined he could without pain.
The internal I-S-K-D implant is FDA approved. It's designed to lengthen for a pre-determined distance and then stop. Full recovery generally takes at least a year.
BACKGROUND: Leg length discrepancy happens when one leg is longer than the other leg, according to Children's Hospital Boston. A difference in leg length can be anywhere from 1 centimeter to more than 6 centimeters. The more the discrepancy, the more likely a person is to suffer from a variety of symptoms. There are many causes of leg length discrepancy. It can result from an injury, such as a fracture that damages the cells responsible for bone growth. Other diseases of the bone can injure a region called the growth plate, where growth in length occurs. Some children are born with legs that are unequal in length or bowed tibias that can cause a discrepancy. Bone tumors and treatments for them are also linked to leg length discrepancy. Tumors can invade the bone's growth plate like an infection, and treatments such as chemotherapy, can also damage the plate.
SYMPTOMS: Although symptoms of leg length discrepancy vary, they often result from alignment problems. Many patients experience gait issues such as limping, toe-walking or rotation of the leg. They may also have a knee that's chronically hyper-extended on the short side and flexed on the long side. Pain in the back, hip, knee, and ankle are also common as are posture problems that could lead to scoliosis.
COMMON TREATMENTS: Sometimes, nonsurgical treatments are used to help leg length discrepancy. These may include wearing orthotics, prosthetics or trying physical therapy. Shoe lifts are a common way to treat discrepancies. There are also several procedures used to shorten the longer leg. These may be recommended when the leg length discrepancy is between 2 centimeters and 6 centimeters at maturity. Shortening is considered safer and results in fewer complications than lengthening procedures. However, lengthening procedures are used and are typically reserved for discrepancies that are more than 4 centimeters. The standard process is technically difficult and has a high rate of complications including pin tract infection, wound infection, hypertension, partial dislocation of the hip and knee, a delayed union of the bone and fatigue fractures after removal of the lengthening apparatus. The standard way to perform a leg lengthening procedure involves using a customized apparatus that encircles the leg and is surgically attached to the limb that will be lengthened by pins.
A NEW OPTION: Orthopedic surgeon Robert Bruce, M.D., from Emory University, offers patients a different kind of procedure that lengthens limbs through a metal rod that is implanted into the patient's leg bone. The Intramedullary Skeletal Kinetic Distractor was FDA-approved in 2001 and is generally covered by health insurance, according to the International Center for Limb Lengthening in Baltimore. The ISKD works in synergy with the body's natural bone healing process to achieve lengthening. As the implant expands, it stimulates the bone to grow around it, and the new growth strengthens over time. It is designed to lengthen for a predetermined distance and then stop. Full recovery typically takes at least a year.
FOR MORE INFORMATION, PLEASE CONTACT:
Emory Health Connection
(Information Provided by: Ivanhoe)
©2007 The E.W. Scripps Co. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
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