The doctor will assess the problem of the patient (which can be bone loss, infection, poor skin cover etc..) and give the best solution. He may advice External Fixator for some cases, that’s because some of the advantages of External Fixator over Nails/ Plates. The advantages are :

  1. External Fixators have least risk of implant related infection, so if you have a history of infection of bones then doctor may advise you to go for external fixator.
  2. Bone lengthening is possible with external fixators (although newer techniqeus like nail assisted lengthening are becoming popular).
  3. External fixators can be used safely for situations where skin is thinned out due to any reason.
  4. With external fixator it is possible to change alignment of leg after surgery also.
  5. Once the bone is healed , external fixator is removed without surgery and there are no implants inside. In case of nail or plate a person has to undergo additional surgery for removal. Besides there are some biomechanical advantages of external fixator which can make bone healing faster, they are not discussed in detail here.

The problems can be

  1. Pain and irritation of skin because of wires and pins
  2. Liquid discharge from wounds
  3. Swelling of the limb
  4. Difficulty in movement of joints (stiffness of joints)
  5. Possibility of infection of pin tracts (wounds which allow the wires/pins to go through bone). In most of the cases infection settles with antibiotic use and regular cleaning
  6. Difficulty in wearing clothes and difficulty in leg movements. The doctor will consider the drawbacks of external fixator against advantages and advise the patient regarding choice of implant (nail/plate or external fixator)

Until the bone is completely healed. The doctor will decide this from your way of walking and xrays and when he feels that the bone is completely healed, he will advise you removal of external fixator. There is no uniform formula unfortunately as the healing time may vary from case to case. Generally it is better to keep the external fixator applied for a month extra than to take the risk of bone breaking again!

Since the external fixator remains applied to the leg/arm for a long time (months) it is preferred that patients themselves learn the cleaning process and they are not entirely dependent on doctor or staff. The doctor and staff will teach cleaning of external fixator after patient has undergone surgery, they will also observe and correct mistakes. Usually cleaning and dressing is done once daily , it involves use of boiled cooled water and sterile dressing material and it is not at all a cumbersome or painful process. The cleaner the fixator, the less is the risk of infection.

Yes, physiotherapy is a must for rehabilitation after deformity correction. Bone healing is not the only thing that matters. Muscle strength, coordination and smooth motion of joints- all are required to achieve a good outcome after surgery. Usually patients learn exercises over a few days and continue throughout the healing period.

When the deformed leg is undergoing gradual correction with external fixator , periodic check ups are needed to monitor the progress , the doctor may modify the frame during subsequent follow ups as per need. Usually patients have to show at interval of 10 to 15 days when the correction is going on. Once the deformity is corrected / length of the leg is achieved then we are just waiting for the bone to heal so visits are less frequent, almost one visit at 3 weeks to 1 month. This continues until fixator is removed.

No. Removal of external fixator can be done under sedation (sleep effect with help of medicines) , it requires half day stay at hospital or less. A brave hearted person may choose to remove fixator without sleep medicines also , but it’s up to the patient finally whether they want removal in awake state or under anesthesia (sleep effect).

Yes, it is possible to increase height with surgery. Bone is cracked in a safe way by the surgeon (the process is called osteotomy ) and it is distracted with external fixator at 1 mm per day. The process of lengthening ends when desired length of leg is achieved and external fixator is kept until broken bone heals. Newer techniques use nails to stabilize broken bone and avoid external fixator.

For more details of Cosmetic Lengthening please click here

Ilizarov fixator assisted lengthening (Osteodistraction) is an established process in orthopaedics and it has stood the test of time. The science of limb lengthening has evolved through several years with better and better results but no surgery is entirely free from risk! Some of the possible complications (side effects) can be stiffness of adjacent joints, failure / delay of the bone to heal, infection , joint dislocation, nerve problems, scars. Risk of these adverse effects is less in the hands of experienced surgeons who do this surgery as a routine. Risk also reduces with regular exercises, proper fixator care by the patient.

If we are talking about Leg Length Discrepancy , which means length of legs is unequal then for an adult up to 15 mm shortening of one leg can be accepted as many of people do not feel any problem in daily life with shortening of less than 15 mm. However this is not a rule, for some cases shortening less than 15 mm may cause problems like clumsy walking , discomfort or pain. In contrast to this, people with more than 15 mm discrepancy may be totally comfortable , especially if shortening has developed since childhood.