Bow leg is a condition where the knee is pointed out and the leg is bent, causing the ankles to be close together and the knees to be far apart when standing straight. Bow legs often come from causes such as genetics, malnutrition, being overweight, or some diseases of the joints.

Parents with bow legs have a higher chance of passing this deformity to their babies. Bow legs can also develop in children who have chronic calcium and vitamin D deficiencies. Babies with excess weight who learn to walk too soon are also more likely to develop bow legs. Bow legs can also be caused by rickets, osteogenesis imperfecta, fractures that are displaced near the knee joint, injuries that cause cartilage damage, and other conditions.

With more than 30 years of experience in the field of surgery and orthopedics, Assoc. Prof., Dr. Le Van Doan has pointed out a number of solutions that can assist people with bow legs to improve this deformity.

Dietary Modifications

One of the causes of bow legs is nutritional deficiencies. Therefore, adjusting the diet and supplementing with suitable substances is a positive solution to solve the issue.

In the daily diet, nutritionists recommend that people with bow legs should increase protein, vitamins, and minerals, especially calcium, vitamin D3, MK7, etc. These substances support the treatment and prevention of rickets and malnutrition while assisting the body’s improved calcium absorption, enhancing bone strength and flexibility.

The following foods should be on the menu because they are high in nutrients and good for bones: shrimp, crab, eggs, milk, fish, etc.

Image of bow legs

Exercising

To improve their bow legs, children need to be encouraged to be active and play sports regularly. Some simple exercises, easy to do at home, such as tiptoe exercises, squats, glute stretching exercises, and using massage rollers, etc, are also recommended.

Regularly performing these exercises will strengthen the legs, ease knee pain, tone the muscles, adjust the knee inward, improve ligament and tendon structure elasticity, etc.

Physical Therapy

Children with bow legs should be taken to medical facilities with specialized physical therapists to get their legs corrected. Depending on the degree of curvature, the doctor will prescribe a physical therapy regimen that includes exercises ranging from simple to complex movements to start the correction.

Exercises will be performed under the guidance and prescription of qualified doctors and rehabilitation technicians. Some basic physical therapy exercises that can be referred to are using leg belts or leg press.

Orthopedic surgery for bow legs

Orthopedic surgery is a successful treatment option when the aforementioned measures fail to improve the condition and the bones and joints have stabilized by the time the patient is 19 to 20 years old. The leg shaft will be surgically adjusted to be straight, attractive, and to enhance the figure. Additionally, this solution aids in weight adjustment to properly focus on the joints, preventing later-onset osteoarthritis of the knee and ankle.

According to Dr. Doan, a bow leg operation typically lasts two hours. A bone is usually cut below the knee, where it is most curved, and then straightened by the surgeon. Depending on the degree of the deformity, the legs will be 1-2 cm longer. Bone from either the donor or the patient will be used to fill the gap. The bone is firmly fixed by the locking screw brace.

After five days of surgery, the patient will be able to stand up and practice walking. After 3-4 weeks, the patient can begin to walk slowly. After 2-3 months, the patient can be active and exercise like a normal person.

Assoc. Prof., Dr. Le Van Doan has successfully performed hundreds of surgeries to correct deformities of the legs and arms, including many cases of severe bow legs. This is a type of surgery that is not too difficult but requires a specialist in orthopedics to avoid complications.

At the same time, this type of surgery needs to be performed at a hospital with modern medical equipment, with a team of highly skilled doctors and technicians, and with dedicated care to guarantee safety and good results.

Link to article on Afamily: https://afamily.vn/phau-thuat-keo-dai-chan-giac-mo-tang-chieu-cao-khong-con-qua-kho-khan-20211228210613908.chn

As society develops, people start to pay more and more attention to each other’s height. Not everyone is born with a desired height. Thus, the need for leg lengthening surgery to improve height is increasing.

So what actually is leg lengthening? What are our safe stretched lengths? How long does it take to return to daily life, will there be any sequelae, etc. These are questions that most people with a “modest” height are interested in.

How does leg lengthening work?

Leg traction surgery is a surgical method to increase the length of the legs by 1mm every day, based on the body’s ability to regenerate new bone on its own, and the recovery of soft tissues, blood vessels and surrounding nerves.

In the past, leg lengthening surgery was only performed for people with limb length discrepancy. However, nowadays, more and more people are choosing this surgery to improve their height to become more confident in life.

So how many centimeters can your legs get stretched by? Assoc. Prof., Dr. Le Van Doan said, depending on the specific condition of each individual, the doctor will examine and advise where the procedure should be performed and how long the legs should be stretched to ensure the best aesthetic result and recovery. Achieving the desired length depends on your age, health status and surgical condition. Your current height, gender and surgical site will determine your stretched length, which can range from 10-12cm.

A method that guarantees safety and fast recovery

More than 10 years ago, just using only the external fixators to stretch will result in the patient having to wear them from 9 to 12 months (average stretching rate of 45 days for each centimeter). Currently, the combination of intramedullary nailing and external fixation is one of the most advanced surgical methods, allowing the lengthening process to still achieve maximum efficiency, while the time having to the fixators is shortened to only ¼ of the original duration (average rate of 10 days for each centimeter). Because in addition to cutting the bone and installing the fixators for daily stretching, the doctors also put into the marrow canal a nail with a screw at the top of the bone. This new method has been applied to hundreds of cases, without any distortion or complication. After recovery, patients can move their legs freely, and even play sports safely.

Patients who underwent leg lengthening usually suffer pain in the first 2 days. After 2 months, they can climb stairs and 20 months later, almost all basic activities are back to normal. The patients can play tennis and many other different sports.

With a shortened duration, scars get smaller (1-2cm) and their number is less. This advanced method is currently being applied in many cosmetic leg lengthening surgery centers around the world and in Vietnam.

Change your life with the decision that “let you be your most confident self”

Not only does leg lengthening make you look more radiant, but it also makes you more confident and strong in life. So don’t be afraid of changes, because the decisions you make now will change your future.

This is a 24-year-old short girl from Saigon. She has a pretty face but her height was only 1.48m. After more than 2 months of surgery, every time she stood in front of the mirror, she burst into tears of joy when she found out that her legs were longer and her body was much taller than before. From then on, Q could confidently walk on the street in her most beautiful dresses.

In addition, people who work in specific fields such as models, actors, international students, etc. because of the nature of their work, have also undergone leg lengthening surgery to gain confidence and have more new opportunities

Many other patients who are overseas Vietnamese and foreigners who are currently living and working abroad, also took advantage of the arrangement to fulfill their dream of leg lengthening, with the desire to have better opportunities in the host country. Such is the case of Preeda, a 23-year-old young man from Thailand, a country famous for many cosmetic services, who also trusted Dr. Doan to conduct leg lengthening surgery on his legs. This affirms that the service quality as well as the expertise and skills of doctors in Vietnam are not inferior to other countries in the world.

Having an ideal height has been the dream of many people. Now, that dream is completely “within reach”. According to experts, improving height is a very significant change in appearance and if that helps you to become confident in life, then this method is the best way to achieve your desired height.

Learn more about leg lengthening:

Hotline: 0587 112 112

Facebook: facebook.com/keodaichandrdoan 

Author links open overlay panel: DoanVan Le LuongVan Nguyen
Read original article: https://doi.org/10.1016/j.ijscr.2021.106577

Highlights

• Tibial pseudoarthrosis with large leg-length discrepancy and extensive scarring was a great challenge.
• The treatment for these lesions was not defined.
• Ipsilateral fibula lengthening then centralization for the treatment of tibial pseudoarthrosis was a safe, rapid, and inexpensive procedure.
• Our procedure was not difficult, and microvascular skills and special devices were not required.
Abstract

1. Introduction and importance

Tibial dysplastic pseudoarthrosis associated with large leg-length discrepancy and extensive scarring was a great challenge for orthopedic surgeons. The treatment for these lesions was not defined.

2. Case presentation

We report a 24-year-old case of dysplastic pseudoarthrosis at the middle third of the right tibia with a 10 cm leg-length discrepancy and a 250 medial deviation and 200 internal torsion due to osteomyelitis 14 years previously. She was treated by fibula lengthening then centralization for the treatment of tibial pseudoarthrosis. Eight months after the operation, the patient reported no pain and became capable of walking without an orthosis. X-rays showed full bone union at the proximal tibiofibular synostosis and the lengthening site of the right fibula. The distal tibiofibular synostosis was healing. The range of movement of the knee and ankle was restored.

3. Clinical discussion

This technique was different from the Huntington procedure. A good union between the transposed fibula and the remaining part of the fibula brought a better strength of the reconstructed tibia. The tibial pseudoarthrosis, leg-length discrepancy, and malalignment had been solved by our techniques. The procedure was easy, rapid, and inexpensive without requiring microsurgery skills and special devices.

4. Conclusion

Leg lengthening then centralization of ipsilateral fibular graft is an excellent option for reconstruction of a tibial pseudarthrosis with a large leg-length discrepancy. It is a safe, rapid, and inexpensive procedure. The procedure was not difficult, and microvascular skills and special devices were not required.

Level of evidence

A case report.

Keywords
Tibial defect
Tibial pseudoarthrosis
Leg-lengthening
Leg-length discrepancy

1. Introduction and importance

Tibial dysplastic pseudoarthrosis with large leg-length discrepancy was a great challenge for orthopedic surgeons, especially when associated with extensive skin and soft tissue damage. The deformities of the tibia with shortened, deviation, dysplastic non-union must be solved as much as possible. The treatment for these lesions was not defined. Reconstruction of this injury could be done by various methods including segmental allograft, vascularized and non-vascularized autograft, induced membrane technique, bone transport, and Huntington procedure. Implantation of segmental allograft and non-vascularized autograft in the tibial dysplastic pseudoarthrosis with surrounding extensive scarring post-osteomyelitis may be at a high risk of failure, like infection, rejection, fractures, and nonunion. The free vascularized bone transfer had been suggested as the leading option for tibial defects of 5 to 12 cm. Although vascularized fibular autografts have distinct benefits and allow simultaneous soft tissue coverage, problems were relatively common. These included infection and stress fracture and could occur at both donor and recipient sites, the hypertrophy of the graft was unreliable. The technique also was an extensive and time-consuming procedure, which requires harvesting a contralateral fibula and microsurgery skills [1], [2]. Huntington procedure has been used for managing complex tibial nonunion with intensive tissue damage [3], [4]. It provided a large graft of the ipsilateral fibula raised on a pedicle of the peroneal artery, aligned and fixed to the tibia; avoiding exposure of the site that is vulnerable to infection and facilitated wound healing without prolonged hospitalization. The Masquelet technique was relatively ineffective in achieving union in the reconstruction of great tibial defects and was associated with a high rate of infection [5], [6]. However, the leg-length discrepancy and an acceptable limb alignment had not been solved by the abovementioned techniques [4], [7]. Leg lengthening had been done following tibial reconstruction. Bone transport also was used for massive tibial bone loss, but if the amount of bone loss was great, the time to achieve the desired length of regenerate could be extremely long with many complications. Bone transport required a one-month consolidation period for 1 cm of regenerated bone and distal consolidation between the distal and transported fragments required 6 months [8]. In patients with massive tibial bone loss, the Ilizarov technique for distraction-compression osteogenesis could be associated used with the Huntington procedure [3]. However, this method was technically demanding and had theoretical risks of complications that may occur even when performed by experienced orthopedic surgeons. Complications included pin site infection (up to 80%), loss of alignment, failure of bone consolidation, nonunion at the docking site (up to 44%) refractures, and scarring [5].

We report a 24-year-old case of tibial dysplastic pseudoarthrosis with a 10 cm leg-length discrepancy due to osteomyelitis. Our case was treated using an atypical procedure by fibular lengthening then centralization for the treatment of pseudoarthrosis at the middle third of the right tibia.

2. Case presentation

This case follows 2020 SCARE guidelines for reporting of cases in surgery [9]. A 24-year-old woman was transferred from a local hospital to our hospital with a diagnosis as pseudoarthrosis of the right tibia due to osteomyelitis. She reported a history of right tibial hematogenous osteomyelitis when she was five years old. She was treated in a local hospital and was under the intervention of removal of dead bone of the right tibia. Unfortunately, she had a purulent at the right post-operatively. She was transferred to the central hospital and had five other operations of debridement. The wound in the right leg had not been healed well until 10 years later. The right tibia had been non-union with leg length discrepancy. After that, she had not been under any treatment. As she was growing up, the shortening and deformity of her left lower leg became obvious. She could walk without crutches, but with difficulty. The patient was well. During the physical examination, upper limbs and spine were unaffected, as well as the left lower extremity. The right hip and knee were stable and normal in terms of the range of motion. There was a 250 varus and 200 internal torsion deformity of the right leg with a 10–cm-leg-length discrepancy. The anterior soft tissue at the middle third of the right leg was in poor condition with extensive scarring and the right foot was in equinovarus deformity (Fig. 1). The movement range of the right ankle was 0° dorsiflexion and 30° plantarflexion. There was no comprimisation of blood flow, sensation, or motor-nerve function. X-rays showed a dysplastic pseudoarthrosis at the middle third of the right tibia with a 10 cm leg-length discrepancy. There was a 250 medial varus and torsion deformity of the right tibia. The right fibula was hypertrophied and curved at the distal third. The ankle joint was nearly normal except for a thickened lateral malleolus. A radiograph showed the pelvis severely tilted to the right (Fig. 1). The patient had no family history of any relevant genetic information, psychosocial history, or relevant pre-existing illnesses. She did not smoke and drink alcohol.

Fig. 1. X-rays and Clinical condition pre-operative. A, B, Clinical condition pre-operative. C, D, CT Scanner of lower extremity and X rays of right tibia and fibula.

Based on her history, physical exams, and X-rays findings, it was determined that she had dysplastic pseudoarthrosis at the middle third of the right tibia with a 10 cm leg-length discrepancy and a 250 medial deviation, and 200 internal torsion due to osteomyelitis 14 years ago. After discussion of the risks and benefits of surgery, the patient decided to undergo the recommended surgical procedure: 10 cm leg lengthening using external fixater after proximal and distal fibular osteotomies and then fibular centralization for the treatment of pseudoarthrosis at the middle third of tibia. The patient underwent surgery in the supine position with spinal anesthesia. She has received a single dose of prophylactic antibiotics before thigh tourniquet inflation. The operative leg was prepared and draped in a routine surgical sterile fashion above the knee. The Nhan’s external fixater was used for leg lengthening in this case. That had been used widely in Vietnam for the management of open fracture for over 20 years.

Nhan’s external fixator was made in Vietnam. The frame consists of two vertical bars (10 mm diameter) (Fig. 1) with opposing threads (1 mm pitch) to stretch or compress the bone by turning. Each bar was 320–350 mm in length and included six operable flat faces at the center, numbered 1-2-3-4-5-6 in the direction of stretching. By rotating each vertical bar three times daily, with each turn equal to one number in the middle of the bar, the pin clamps at the proximal and distal of the bar would expand approximately 1 mm.

A 3 cm longitudinal incision was done at the lateral border of the proximal fibula. The fascia was opened then the peroneal nerve was identified and retracted laterally. The fibula neck was exposed and osteotomized using a chisel. A 2 cm longitudinal incision was done at the lateral border of the fibular distal third. The fascia was opened then the fibula was exposed and osteotomized using a chisel about 6 cm proximal to the distal fibula. The internal torsion deformity of the leg was reduced. The Nhan’s uniplanar both-side external fixater was applied at the right tibia with four Steinman pins and one Schanz pin. Two Steinman pins and a Schanz pin were inserted at the proximal third of the tibia, two Steinman pins were inserted at the distal third of the tibia. The incisions were sutured (Fig. 3). Lengthening started at day 5 with a 1/3 mm extension applied four times daily. The patient was discharged 10 days postoperatively. Before discharge, she was instructed regarding properly performing distractions at home. She was permitted partial weight-bearing activities with crutches. Seven weeks post-operatively, the distal fibula was medialized and fixed to the distal tibial segment using a lag screw. A percutaneous Achilles tendon tenotomy was done and the right foot was fixated by an external fixater at the same time to correct equinovarus deformity of the right foot. She was instructed regarding properly performing a gradual reduction of right tibial varus deformity during lengthening at home. Every three weeks follow-ups were conducted. 14 weeks post-operative, the right leg had been lengthened 10 cm. The proximal fibula was medialized and fixed to the proximal tibial segment using lag screws. The external fixater was removed and the patient applied a long-leg orthosis (Fig. 2). 18 weeks post-operative, the proximal and distal tibiofibular synostosis were applied iliac crest bone graft and the patient was permitted partial weight-bearing activities with crutches for 2 months. After that, she could walk without crutches. 8 months after the operation, the patient reported no pain and became capable of walking without an orthosis (Fig. 3). X-rays showed full bone union at the proximal tibiofibular synostosis and the lengthening site of the right fibula (Figs. 3). The distal tibiofibular synostosis was healing, it required bone graft again which she refused. The range of movement of the knee and ankle was restored. She is now checked regularly monthly by the authors. The patient reports being very satisfied with the overall results.

Fig. 2. X-rays and clinical condition during lengthening period. A, B, Clinical condition and X-rays post-operative. C, X-rays 3 weeks post-operative. D, E, Clinical condition and X-rays 7 weeks post-operative. F, G, Clinical condition and X-rays 14 weeks post-operative. H, Clinical condition 18 weeks post-operative.

Fig. 3. Clinical condition and X-rays 8 months post-operative.

3. Discussion

Tibial pseudoarthrosis due to trauma or osteomyelitis was not rare. However, our case caused by osteomyelitis during her childhood was quite distinct from the other tibial pseudoarthrosis. It was a tibial dysplastic pseudoarthrosis at the middle third with a 250 medial deviation and 200 internal torsion of the tibia, 10 cm leg-length discrepancy, the hypertrophied curved intact fibula, and intensive scarring at the anterior tibial pseudoarthrosis. The fibula was curved and torsional at the distal third. This lesion was a great challenge for orthopedic surgeons and reconstructive surgeons. The deformities of the tibia with bone defects, dysplastic non-union, deviation, torsion, and leg length discrepancy must be solved as much as possible. It was a considerable surgical challenge, especially when associated with extensive scarring at the anterior aspect at the middle third of the leg. Management of these injuries depended on surgeon experience and training. Reconstruction of this injury could be done by various methods including large segmental allograft, vascularized and non-vascularized autograft, induced membrane technique, bone transport, and Huntington procedure.

Implantation of large amounts of allograft, induced membrane technique or non-vascularized autogenous fibular graft for reconstruction of large tibial defects had been associated with greater risk of infection, graft rejection, fracture, nonunion, and fear of disease transmission, especially when associated with extensive scarring, and the fibular graft may not undergo hypertrophy [5], [6], [10]. It also did not solve the leg-length discrepancy.

The most common methods of treating a segmental bone defect are either with the use of a vascularised fibular autograft or by bone transport using the Ilizarov technique [1]. Bone transport required a lengthy procedure which limited its use in the reconstruction of tibial defects with a big gap. If the amount of bone loss was great, the time to achieve the desired length of regenerate could be extremely long with frequent follow-ups to identify and manage various obstacles and complications such as high rate of infection, equinovarus, deviation deformity, osteomyelitis, refractures, nonunion, pain and discomfortable condition due to a long time of wearing external fixater [1], [2], [11], [12], [13].

The free vascularized bone transfer had been suggested as the leading option for tibial defects of 5 to 12 cm. However, it was an extensive and time-consuming procedure, which required harvesting a contralateral fibula and microsurgery skills. There were many other complications such as flap necrosis, deep infection, but hypertrophy of the graft was unreliable and late fracture, peroneal nerve injury [1], [2]. It also did not solve the leg-length discrepancy.

The Huntington procedure was popularized by Huntington to manage tibial defects with intensive soft tissue injury [3], [4]. It provided a large graft of the ipsilateral fibula raised on a pedicle of the peroneal artery, aligned and fixed to the tibia. The transposed fibula had muscles attached to it, along with its nutrient artery supply, this helped in the good union of the fibula that would substitute the tibia for normal activities. The Huntington procedure avoided exposure of the site that was vulnerable to infection. Both these factors helped reduce the post-operative infection. The procedure was easy to perform without requiring special equipment. However, leg-length discrepancy and malalignment were seen in all patients, and hypertrophy of the fibular graft was unreliable and late fracture [4], [7]. Catagni [3] reported two cases of tibial defects with the leg-length discrepancy in which ipsilateral fibular was gradually medial transferred using the Ilizarov apparatus combined with distal and/or proximal tibial lengthening using any residual tibial bone in the same limb. However, this method was technically demanding and had theoretical risks of complications such as neurovascular injury, infection, muscular damage, articular injury, deep venous thrombosis, refractures, deformities, and scarring.

In our cases, she had a dysplastic pseudoarthrosis at the middle third of the right tibia with a 10 cm leg-length discrepancy, a 250 medial deviation and 200 internal torsion, and extensive scarring so we combined the leg-lengthening according to Ilizarov technique and Huntington procedure for her treatment. The right leg was lengthened using an external fixater to solve leg-length discrepancy after the ipsilateral hypertrophic fibula was osteotomized at the proximal and distal third, then medialized the fibula and fixed the ipsilateral fibula to the tibia using leg screws and applied iliac bone graft. The tibial varus deformity was gradually reduced using an external fixater during lengthening. It was easy for the patient to adjust the Nhan’s external fixater at home. This frame was made in Vietnam, it was cheap and available. Our patient had been applied an iliac bone graft at the proximal and distal tibial-fibular synostosis because of the dysplastic pseudoarthrosis at the middle third of the right tibia.

We had done fibular osteotomy with the maintenance of the periosteum above and below the osteotomy. The right leg was lengthened using the external fixater. This resulted in a good union between the hypertrophy transposed fibula and the remaining part of the fibula in our case, which brought a better strength of the reconstructed tibia. This technique was different from the Huntington procedure. Our technique was an easy, rapid, inexpensive procedure without requiring microsurgery skills and a special device, with a shorter time of wearing external fixater than bone transport. The patient had to wear the frame for 14 weeks then wear the orthosis until six months post-operative. This technique had great advantages of preserving the patient’s limb, with the better psychological aspect.

Some authors encountered iatrogenic common peroneal nerve injury while osteotomy and attempting to medialize the fibula into tibia in patients with extensive soft tissue fibrosis [4], [14]. In our case, the fibula had been osteotomized and lengthened before being medialized to the tibia. So, we did not encounter any difficulty during the medializing fibula and fixation fibula to the tibia. The common peroneal nerve was identified during fibular osteotomy. We did not encounter nerve injury complications in our case.

4. Conclusion

Leg lengthening then centralization of ipsilateral fibular graft is an excellent option for reconstruction of a tibial pseudarthrosis with a large leg-length discrepancy. It is a safe, rapid, inexpensive procedure. Our procedure was not difficult, microvascular skills and special devices were not required.

Funding

No financial support was received for the completion of this study.

Ethical approval

All procedures were approved by the 108 Central Military Hospital’s Institutional Review Board, Hanoi, Viet Nam.

Consent

Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.

Authors’ contributions

Dr. Doan Van Le: Conceptualization, Surgery, Writing – Review & Editing, Supervision.

Dr. Luong Van Nguyen: Conceptualization, Surgery, Writing – Review & Editing, Supervision.

Registration of research studies

Not applicable.

Guarantor

Dr. Luong Van Nguyen.

Provenance and peer review

Not commissioned, externally peer-reviewed.

Declaration of competing interest

The authors declare that they have no conflicts of interest.

Acknowledgments

The authors would like to acknowledge with gratitude the precious help of colleagues and the health staff of the Institute of Trauma and Orthopaedics at the 108 Central Military Hospital for the time required to prepare and implement this study.

Availability of data and materials

The data used to support the findings of this study are available from the corresponding author upon request.

In recent years, leg lengthening surgery to improve height has helped many people with short stature and those with injuries related to leg length discrepancy fulfill their dreams.

Despite this, it is still believed that leg lengthening is a risky, costly and time-consuming method that can lead to many complications and cause the patient to stay idle for a period after the surgery. In order to have the simplest and easy to understand view on leg lengthening, let’s take a look at the procedure, conditions, level of safety along with the trusted surgeons that will perform this important type of surgery.

Principle, procedure and and level of safety

The principle of leg lengthening, is based on the discovery that the body has the ability to create and form new bones on its own when the bones are cut apart and slowly pulled. This is an important discovery of Professor Ilizarov, a Russian doctor in the 50s of the twentieth century.

Many people still think that after the surgery, patients will have to stay “motionless” for a whole year. When you think about surgery and the use of cutting tools, you cannot stop yourself from feeling afraid of the pain that will come along. However, according to experts, thanks to stretching tool and the help from advanced pain relievers, after the surgery, patients will only suffer from minor pain in a short period of time. Patient N.T.H (24 years old) who underwent leg lengthening surgery a year ago shared about his story: “Starting from the second day after the operation, I could already get up by myself to eat, drink and watch TV. On the third day, I could get to my wheelchair to start moving around. After 10 days in the hospital, I was sent home and was able to return to my daily routine without any help or assistance from my family.”

Assoc. Prof., Ph.D. Le Van Doan doing a check-up personally for a patient who has completed his lengthening phase and was preparing to get the fixators removed

Over 10 years ago, if you only used external fixation in leg lengthening, the lengthening phase would take between 9 and 12 months (average stretching rate of 45 days for each centimeter). Now, the combination of intramedullary nailing and external fixation is one of the most advanced surgical methods, helping lengthening phase reach its maximum efficiency and reducing the time that patients have to carry the fixators by 75% (average stretching rate of 10 days for each centimeter). This is possible because along with osteotomy and installing daily stretching external fixators, doctors also place an intramedullary nail inside a medullary cavity with a stopper at the top of the upper bone. This new method has been applied to hundreds of cases without any failure, deformity or complication. After recovery, leg lengthening patients can move freely and even do high-intensity activities or play sports safely.

With reduced duration and fewer and smaller surgical scars, this advanced method is currently being used by cosmetic leg lengthening centers in Vietnam and around the world.

Before performing the surgery, doctors will discuss about the desire of each patient to give appropriate advices

Hundreds of successful leg lengthening surgeries that help change the lives of many

After having successfully performed hundreds of leg lengthening surgeries, Assoc. Prof., Ph.D. Le Van Doan could still recall perfectly each case and the desires of his patients. According to the doctor, all of his patients when coming to his clinic all shared an overwhelming inferiority about their heights that resulted in them being unable to socialize with their peers and being insecure and reserved all the time.

One of his patients was a female university student who was as small as a piece of candy. She had a pretty face but her height was only 138cm and she weighed over 35kg. After receiving detailed advice and a clear treatment plan, without any hesitation, the young girl agreed immediately to undergo the leg lengthening procedure.

After more than 3 months, she burst with joy to when her height was increased by 8cm. She was also the patient with the shortest height that received leg lengthening treatment from the doctor.

A patient before and after receiving leg lengthening surgery

Another patient was an over 40 male actor who was only 164cm tall. He decided to undergo leg lengthening treatment to get more job opportunities and more acting roles. There was also a patient who was already 172cm tall but had a long back. He wanted to pursue a modelling career, therefore he even flew from Saigon to receive the procedure. After a year, he could walk with confidence on the catwalk with his new height of 180cm that no colleague can recognize.

Many patients were international students who felt inferior about their heights after spending a time studying abroad. They made use of their summer breaks or took a year off to undergo leg lengthening surgery with the hope that they could get more job opportunities or settle down in a foreign country.

Not only in Vietnam, even for people in medically advanced countries, there are still demands for leg lengthening service. This shows the level of safety and efficiency of this method as well as the current expertise and high skills of medical doctors in Vietnam.

There is also a case where a girl of Vietnamese origin who was living and working in the UK, also decided to take a year off work to return to Vietnam to perform surgery to improve her height of 149cm, due to being unable to integrate with the environment abroad.

A trusted doctor in Vietnam

Leg lengthening is a rather complicated technique which is not only about bone surgery but also requires knowledge, qualifications and experience, as well as specialized facilities and tools. Therefore, each patient needs to prepare himself mentally and choose a reputable, ethical and highly qualified surgeon to ensure the safety of his surgery.

Among many medical facilities and hospitals across the country, you can refer to the website drdoan.vn. This is a website created by Assoc. Prof., Ph.D. Le Van Doan directly created so that those who are interested can learn, consider and prepare carefully before undergoing surgery.

Assoc. Prof., Ph.D., Dr. Le Van Doan is one of most experienced specialist in leg lengthening surgery in Vietnam

Dr. Doan has had 15 years of experience as a doctor directly operating in surgery and treatment, with many years holding important positions such as Head of Department or Director. As early as 1991, Dr. Doan was assigned to be in charge of treatment and monitoring of the first leg lengthening surgery. Through daily practice of leg lengthening, combined with reference to the experience of leg lengthening surgeons around the world, his research team has continuously improved surgical instruments and techniques to suit Vietnamese patients’ economic and anthropometric conditions.

Over the past 30 years, Dr. Doan has consulted, monitored, directly operated and treated more than 500 cases of leg lengthening, including more than 300 successful cases of leg lengthening to improve height. According to the sharing of most of his patients, Assoc. Prof., Ph.D., Dr. Le Van Doan, Director of the Institute of Traumatology and Orthopaedics – 108 Central Army Hospital, is one of the most experienced specialist in leg lengthening surgery in Vietnam and a trusted doctor in this field, helping his patients feel reassured and ready for their life-changing surgeries.

The thigh and lower leg are two positions that doctors can choose to perform leg lengthening. However, they would prefer the lower leg over the thigh for leg lengthening procedures due to the following reasons:

Femoral lengthening characteristics

When performing leg lengthening using external fixation combined with intramedullary nailing to create healthy bone cavity, the average healing rate is between 35 and 45 days per cm. Patients are able to get their external fixation removed early, minimize their chance of getting complications after the external fixation is removed and improve the result of their rehabilitation exercises.

Despite this, there are some common complications when performing femoral lengthening using external fixation such as:

• Limiting knee flexion and hip joint extension.
• High risk of deep infection in patients with history of open bone fracture, osteomyelitis, or because the Schan and Kirschner pins got caught in the intramedullary nail.

The two aforementioned complications are acute as they can affect the result of the surgery.

In addition, there are several disadvantages:

• The external fixation is bulky and cumbersome, greatly affecting daily activities.
• Surgery scars are longer. The procedure leaves more scars and they are uglier due to the pins from the fixation piercing through the muscles. During the lengthening, muscle and skin often get torn.
• The patient is likely suffer from pin site infection due to the pins piercing through huge muscle bulks in the thigh.
• When carrying the fixation, it is more difficult to practice moving the knee joints, leading to inconveniences to daily life.

For the tibia, the ring external fixator will be often used with 4 Kirschner pins that are 1.8mm long. These pins are pierced through both ends of the tibia and they are nowhere near the external fixation. The installation of the eternal fixator in the femur is more complicated than that in the tibia.

Tibial lengthening characteristics

Tibial lengthening helps making the legs look longer than if the procedure is performed in the femur. This is because it is easy to observe the position of the knees and toes, but it is difficult to observe the position of the hip joint. Moreover, when we wear our belts in a high position, our hip joint position seems to look higher. When this happens, as people look at our long legs, they will think that the other part of our bodies is at normal proportion and have the impression we are tall. In addition, wearing skirts will show the length of our lower legs, not our thighs.

Technically, tibial lengthening can be performed through one single surgery at a reasonable time. Femur lengthening would require two steps in preparing and performing the procedure in one surgery or two separate surgeries would increase operative time and costs. In addition, tibial lengthening causes less blood loss than femoral lengthening.

Tibial lengthening is easier as carrying two external fixators in the lower legs is more comfortable than carrying them in the thighs.

Femur has mal-aligned mechanical and anatomical axes, therefore tibial lengthening will be more psychologically suitable than femoral lengthening.

Moreover, for tibial lengthening: The number of scars is smaller. The scars are smaller and less unsightly. There is a lesser risk of getting pin site infection and it is easier to practice rehabilitation exercise during the fixation.

Therefore, when performing leg lengthening procedure to improve height, the prioritized position to perform the lengthening is the two lower legs.

In the field of beauty care, stem cells are also researched and applied by many prestigious beauty centers around the world.

Since 2008, the research team from the Institute of Traumatology and Orthopaedics, led by Dr Doan, has reported on the applications of stem cells from autologous blood to treat difficult-to-heal musculoskeletal injuries. Particulary, there have been applications in leg lengthening methods. The report belongs to an independent state-level project, which was accepted in 2011.

According to this study, the use of stem cells extracted from autologous bone marrow blood to inject into the bone cavity has significantly shortened the duration compared to the method that does not use stem cells (on average, bone healing without stem cells requires 45 days per cm, while the process with stem cells only need 30 days).

Therefore, this is a very good supplementary method for those who undergo leg lengthening in order to shorten the recovery time and quickly return to normal life and work.

The accepted report of the research team on stem cells

Member list of the research team from the Institute of Traumatology and Orthopaedics – 108 Military Central Hospital

On July 12, 2020, stem cells were injected into a 6.5cm extension cavity that, picture of grade 1 bone cavity.

Image of bone examined after 2 months since it received stem cell injection (film taken on September 12, 2020, when the bone cavity has developed to grade 3).

Báo cáo nghiệm thu đề tài của Nhóm nghiên cứu tế bào gốc.

Danh sách Nhóm nghiên cứu của Viện Chấn thương Chỉnh hình – Bệnh viện TWQĐ 108.

Ngày 12/7/2020 đã tiêm tế bào gốc vào ổ kéo dài 6,5cm, hình can xương độ 1.

Hình ảnh can xương kiểm tra sau tiêm tế bào gốc 2 tháng (phim chụp 12/9/2020, can xương đã phát triển độ 3).

]]> /en/when-do-i-need-to-undergo-achilles-tendon-lengthening/ Mon, 23 Aug 2021 15:09:36 +0000 /?p=6918 Achilles tendon lengthening is usually indicated when the legs are overstretched (over 6-7cm for women and over 7-8cm for men) or during the lengthening procedure, the patient did not do any exercises or were scared to get hurt that he did not take any rehabilitation excercises. When the Achilles tendon suffers equinus and rotates inward, rehabilitation exercise and walking in the future will be difficult.

Depending on the level of tendon contracture, the doctor will decide whether to perform this procedure or not. The Achilles tendon lengthening procedure is simple to perform, with only 2 small scars of 0.5cm and having a cast for fixation for 4 weeks,. After that, rehabilitation exercise is much easier which leads to reduced healing time. Many patients can walk with their heels touching the ground normally just after 6 weeks.

Below is the photo of a female patient who had her legs stretched by 6.5cm and her height changed from 158cm to 165cm. She underwent Achilles tendon lengthening and could walk normally after 2 months since her fixators got removed.

This is a fixator made by Dr Doan and the research team of 108 Military Central Hospital. The fixator is dedicated only for leg stretching. It was registered and licensed at the Intellectual Property Office of Viet Nam – Ministry of Science and Technology. The fixator is designed for simple operation, consisting of 3 pile rods with opposite threads. The stakes are connected with 2 semicircular rings at the 2 ends. Each semicircle holds 2 small nails pierced through the bone. At the center of the rods are the sides that form a hexagon. Therefore, it can be adjusted to stretch or squeeze easily when desired. Turning one round is to stretching or squeezing in 2mm, so turning 3 sides a day is equal to 1mm and turning 1 side is equal to 1/3mm. To further understand how to stretch, please watch the detailed video below with specific instructions from Dr. Doan.

What is leg lengthening?

Speaking more about this method, Assoc. Prof. Le Van Doan stated that limb lengthening, particularly leg lengthening, is not a complex procedure. This technique has been developed for over a hundred years, originally created to treat patients with leg length discrepancy caused by sequelae from war injuries or labor, cases of osteomyelitis or the need to cut bone tumors; patients suffering from polio; etc.

In Vietnam, since 1995 when polio was eliminated thanks to the expanded vaccination program, the number of cases of leg length discrepancy has also decreased significantly. However, the causes of trauma after accidents and osteoarthritis still cause many patients to suffer from this deformity. In particular, the need to undergo leg lengthening for aesthetic purposes has also increased significantly.

At the Institute of Traumatology and Orthopaedics, 108 Military Central Hospital, each year Assoc. Prof. Doan and his colleagues perform dozens of stature lengthening procedures to increase height. Particularly, the number of male patients is greater than that of female patients. According to the doctor, self-deprecation related to height has hugh impacts on life, which leads to the need for limb lengthening. For men, this type of self-depracation is more clearly felt.

Assoc. Prof., Dr. Le Van Doan said, in theory, the leg length can be stretched as much as possible, depending on the needs of the patient. But experts always advise them of the right length that is proportional to the body as well as ensure minimal complications.

Regarding the method of implementation, in the past, we used the osteotomy method, piercing 8 nails through the bone and installing an external fixator to slowly stretch at a rate of 1mm per day. Thus, if you wanted to extend 7 cm, it would take 70 days. When it reached 7 cm, it ws still necessary to wear the frame for the next 7 months to make the bone strong, then you could remove the fixator. So the patient had to wear the fixator for a long time up to 10 months, which was very cumbersome in daily life. Now, thanks to the application of new advancement, before performing osteotomy, doctors will put a nail in the bone marrow canal, using only 4 small nails through the two ends of the bone. When stretched to full length, the fixator will be removed. The nail located in the canal will hold the role of fixation while waiting for the cavity to solidify. Thus, with this new method, external fixation duration has been shortened, to only ¼ of its original duration, the early removal of the fixator help the patient to quickly return to daily work and life. The scars are also small and their number is reduce greatly.

Who can undergo leg lengthening?

According to Assoc. Prof. Le Van Doan, indications for leg lengthening are only for people of short stature (female under 150cm, male under 160cm) or people suffering from deformities and injuries. This technique does not apply to cases where leg length discrepancy is not more than 3 cm. With a small discrepancy, it can be improved by simply adding a shoe sole which is much easier.

Regarding the appropriate age to perform leg lengthening, this expert said that it should be between 20 and 30 years old because at that time, the surgeon can determine the perfect height. After the age of 35, the bones begin to age, so they are no longer suitable for prolonged surgery.

After the lengthening, will the leg get weak?

Regarding this relatively common concern, Assoc. Prof. Doan said, limb lengthening does not in fact affect the life expectancy of the surgical patients like many might mistakenly believe. However, after the process, the soft tissues (tendons, muscles, nerves, blood vessels, and ligaments) cannot keep up with the new situation right away. Therefore, rehabilitation exercises are recommended for a while, the duration will depend on the natural disposition of the body and specific desired length. When the muscles, bones and joints have been stable and had good exercise and the lengthened limbs are healthy, the patient can walk, jump, dance, and return to normal life.