How did surgeon ‘lengthen’ bones of this UAE resident?

By Angel Chan

Patient regains normal lifestyle after 12 years of back pain

DUBAI 4 November 2017: A 28-year-old UAE resident has successfully undergone a life changing operation to lengthen the bone in his left leg.

The patient initially reported a lower back ache to Dr. Mohammed Khadder, Consultant Orthopedic Surgeon in Zulekha Hospital, Dubai. After a thorough check, the diagnosis revealed that the patient, Abdalla had an unequal limb length which had been acquired following surgery he had undergone 12 years earlier to treat bone sarcoma. Cases of tumors requesting for these types of surgeries are rarely reported.

In many cases, patients with bone tumors die within five to seven years depending on the severity. Abdalla has been lucky as he had the sarcoma surgery many years ago and the complication identified was only the shortening of his limb. For many years, he used shoe lifts to ease the pain when walking on the street. While at home, the office or while out and about, he could not use the shoe lift all the time as this led to chronic back pain, tilting of the pelvis and can cause osteoarthritis of the hip and knee in future.

Rare Surgery

Dr. Khadder took the opportunity to educate Abdalla on the treatment options with the bone lengthening procedure. These kinds of surgeries are very rare and often chosen to be carried out by expert surgeons in order to normalize a patient’s lifestyle. Abdalla was happy to know that he has a beneficial option and was positively hoping to regain his normal lifestyle. A few days later the left tibial osteotomy was completed followed by the fixation of the Taylor Spatial Frame (TSF), an external fixator used by pediatric and orthopedic surgeons to treat complex fractures and bone deformities.

Dr. Khadder said: “When we started these types of surgeries, these were only pediatric, but with time, we now have adults coming forward to regain their normal postures after suffering fractures, war injuries, previous surgeries, tumors, and other diseases that affect the growth or integrity of the bone. For pediatric cases, most often they are due to congenital malformations involving the tibia, femur, upper limb or lower limb. We have the necessary expertise to treat such cases successfully in UAE.”

“While the lengthening can be done above or below the knee in such cases, this was a tibia lengthening instead of the femur bone as it was healthier and involved fewer complications following the previous sarcoma surgery. Eventually, we were able to achieve normal lengthening on the same side as the previous surgery.”

It is often the case that patients walk in with complaints of back pain not knowing the cause and that there are solutions for shortened limbs. When educated on the benefits and side effects of treatments that would prevent future problems, hip or knee complications, patients are more than willing to go for the procedures and get back to good life.

Little by Little

The duration of the procedure depends on the amount of lengthening desired. One millimeter per day or three centimeters per month is the typical period of treatment. An additional one month is then required for the bone to harden. Abdalla’s procedure was planned for a period of two and a half months. Following surgery, the patient is given a table of instructions and exercises to further contribute to the healthy lengthening process.

Abdalla says: “I am very thankful to the team at Zulekha Hospital who proactively educated me on the option available to me to be able to walk normally again, and I am happy to have taken the decision of undergoing this treatment. I look forward to happier and healthier days ahead.”

Post-surgery treatment is essential as the surgeon can further modify the length of the bone as well as shift or rotate it without any casts or surgeries. No major complications or side effects are foreseen, except that there could be infections or soft tissue contractions around the joints which can be taken care of with physiotherapy. A high protein and high calcium diet is recommended for Abdalla in order to go back to normal walking, running and sports within a few months.