LEG LENGTHENING SURGERY WITH THE FITBONE® METHOD

Doctor Ginebreda is one of the surgeons authorized to perform leg lengthening surgery with the Fitbone method.

The intramedullary nail corrects limb deformities in patients with a shorter leg, thus optimizing leg lengths discrepancies. The system is made up of a self-expanding device capable of gradually increasing the length of the treated bones. It can be implanted in the tibia and femur, in one leg, or both.

Height increase surgery performed with Fitbone has many advantages over traditional external fixators:

– The patient can walk from day one.

– After the surgery, the recovery is entirely painless.

– Low risk of infection.

– Hospitalization and treatment time is reduced.

– Patients can resume their routine activities more quickly.

WHAT ARE LIMB LENGTHENING DEVICES?

Height increase surgery uses external or internal orthopedic lengthening devices, each with its indications and benefits.

The ones that remain outside the limb are known as external fixators, such as the Ilizarov device.

Conversely, internal lengthening devices are surgically placed into the bone, such as the Precice nail or the Fitbone System.

WHAT IS LEG LENGTHENING SURGERY WITH THE FITBONE METHOD?

The Fitbone method uses a self-expanding internal device (an intramedullary nail or rod) manufactured by the German company Wittenstein.

The nail is surgically inserted into the bone (tibia and/or femur). After the nail placement procedure, the patient is hospitalized for five days to allow the bones to rest and begin the healing process. This period is known as the latency period. Then, the distraction phase or pulling apart of the bones begins.

After programming the intramedullary nail, the device is able to gradually lengthen the bones thanks to an electronic motor inside it.

An external remote control sends an electric impulse to a receiver placed under the skin of the thigh or shin. Then, the impulse is sent to the nail’s internal motor, causing it to elongate gradually. The device extends similar to a TV antenna does.

Thus, the Fitbone mechanism is programmed to regulate the lengthening process. Slowly but surely, as the space between the ends of the bones widens, the body produces new bone tissue (callus) to fill the gap until the desired length is reached.

Indeed, legs can be successfully lengthened thanks to the tremendous regenerative capacity of bone tissue. In addition to bone formation, the skin, surrounding soft tissues, and nerves grow along, in the same way, to fit the new lengthened bone.

IS THE FITBONE SYSTEM THE SAME AS THE STRYDE® WEIGHT-BEARING LENGTHENING NAIL?

Both lengthening devices work using the same principle. However, the STRYDE nail comes with a magnetic gear system inside it.

An external remote control (portable magnet) rotates the magnet inside the nail, gradually elongating it and, therefore, the bone. So, it doesn’t need a receiver placed under the skin.

Additionally, the STRYDE® weight-bearing lengthening nail is made of stainless steel, nearly four times stronger than titanium. Thus, the STRYDE® nail allows for full and unrestricted weight-bearing during both the distraction phase and bone consolidation.

Conversely, the Fitbone system only allows weight-bearing as tolerated during the consolidation phase. However, the STRYDE® weight-bearing lengthening nail is pricey and offers comparable results.

HOW MANY CENTIMETRES CAN YOU GROW?

The intramedullary nail achieves a lengthening of up to 60 mm in the tibia and 80 mm in the femur.

Thanks to this technology, you can grow 1 millimeter per day. Therefore, for 40mm, about 40 days are needed. Lengthening is usually carried out using the remote control three times a day (0,33 mm x 3).

Conversely, with the conventional system of external fixators, it would take five more months to reach the desired length. However, even with internal lengthening devices, this procedure is far from simple to go through.

If you have your leg lengthened, you must commit to the recovery process, beginning the day after surgery. This includes a program of intense physical therapy and muscle stretching. So, the lengthening process, including bone healing and recovery, could take four to five months in total.

After the bone is healed (about 18 months after implantation), the intramedullary nail is removed.

HOW MANY STEPS DOES THE SURGERY TAKE?

Leg lengthening surgery is performed under general anesthesia, so you will be asleep throughout the surgery without feeling any pain or discomfort.

First, your surgeon will perform an osteotomy. He will make an incision in the bone (tibia or femur). This is where the new bone tissue will grow. Then, the lengthening device (aka Fitbone) is pushed through and placed inside the cut bone. Screws are also placed to secure the lengthening device inside the bone cavity. Finally, the skin incisions are closed with stitches.

In patients who need to lengthen both legs, Doctor Ginebreda recommends performing limb lengthening simultaneously. This avoids having to schedule two surgeries and shortens the recovery time.

However, remember that you must have a second surgery to remove the intramedullary nail between 18 months and two years after the end of treatment.

LIMB LENGTHENING SURGERY CAN HAVE NEGATIVE EFFECTS IN THE LONG TERM?

The surgery has no adverse effects in the long term. The main goal of this treatment is to allow the patient to return to his previous physical state and engage in sports activities without any limitations.

Certainly, the lengthened bone is a healing tissue at the beginning, but after full consolidation, it should have all the features and endurance of the original bone. In fact, the lengthened bone should have a harder consistency than the original one. So, by all means, it won’t be weaker.

WHICH PATIENTS CAN UNDERGO THE SURGERY?

Ideal candidates are patients with medical conditions, such as congenital or traumatic dysmetria. Other conditions include femorotibial disproportions (asymmetries of the lower limbs).

When dysmetria is mild, elevator shoes or heels are usually used. However, surgery is highly recommended when the dysmetria is greater than 3 cm.

Leg lengthening surgery with the Fitbone method is also used in patients with dwarfism, mainly patients with achondroplasia.

Doctor Ginebreda usually recommends this procedure for male patients with short stature, mainly below 1,65 m. Moreover, ideal female candidates are under 1,55 m of height.

However, some patients may want to stretch their legs for cosmetic reasons. Indeed, this procedure can correct any limb lengths discrepancies or make you look taller. However, there is always a previous medical and psychological assessment in these cases. Surgery to get taller must be approved by a surgeon and justified. Also, it is essential to achieve a proportionate result.

Leg lengthening surgery - Dr Ginebreda

WHAT ARE THE ADVANTAGES OF THE FITBONE TECHNIQUE?

First of all, the intramedullary nail is a highly reliable and technologically tested mechanism. Also, it is completely biocompatible, with no chance of rejection or harming your body.

Also, unlike the traditional external fixators, the Fitbone technique is a more comfortable treatment option. It allows the patient to perform low-impact activities.

Indeed, during the treatment, the patient can carry out activities such as walking without any limitations. No external, voluminous, or uncomfortable metal frames!

Also, it is a less painful treatment. The new bone tissue grows, and you won’t experience pain or discomfort after the first week.

In addition, compared to the traditional methods, the Fitbone technique decreases the risk of infectionScar formation and hospital stay are also reduced due to the minimal incisions.

Patients can resume their routine activity in a short time. So, after the surgery, the downtime is minimal.

IS THE FITBONE METHOD RECOMMENDED FOR CHILDREN?

Limb lengthening with the Fitbone method is not recommended for children under ten years old. From the age of 16, once the growth cartilages have been closed, the patient can consider a surgery.

For cases between 11 and 14 years old, doctors must assess the patient’s specific characteristics (difference in length, remaining bone growth, and degree of deformity) to make the final decision.

HOW MUCH IS LIMB LENGTHENING SURGERY WITH THE FITBONE METHOD?

The cost depends on several factors. Our team will carefully analyze your request. If you would like to receive an approximate quote, please complete the contact form.

Also, if you wish, you can schedule an appointment with Doctor Ginebreda to review your case. It is also possible to schedule the first consult remotely (by video call).

We have qualified staff who will advise you in your language and accompany you throughout the hospital process. In addition, Doctor Ginebreda speaks fluent English.

WHY IS DOCTOR IGNACIO GINEBREDA YOUR BEST OPTION?

Bachelor in Medicine and Surgery (1979, University of Barcelona, Spain). Specialist in Orthopedic and Trauma surgery (1982).

Member accredited by the German company Wittenstein for the use of the Fitbone technique.

Head of the bone reconstruction and lengthening unit. Dexeus University Hospital (since 2013).

Director of the Catalan Institute of Traumatology and Sports Medicine (ICATME) since March 2020.

Member of the board of directors of the International Limb Lengthening and Reconstruction Society.

Doctor Ignacio Ginebreda speaks French and English fluently.

LATEST AWARDS OF EXCELLENCE.

– Award of excellence ‘Best scientific publication’ for the article Surgical technique and outcomes for bilateral humeral lengthening for achondroplasia: 26-year experience (2020).

– Award of Excellence at the Congress of the Spanish Society for External Fixation and Reconstruction of the Musculoskeletal System. (Barcelona, 2016)

– Alpe Foundation Award of Excellence for Achondroplasia (2014).

BIBLIOGRAPHY AND PUBLICATIONS:

Persistent and Stable Growth Promoting Effects of Vosoritide in Children With Achondroplasia for up to 2 Years: Results From the Ongoing Phase 3 Extension Study. Ginebreda I, May 2021

Articles Once-daily, subcutaneous vosoritide therapy in children with achondroplasia: a randomised, double-blind, phase 3, placebo-controlled, multicentre trial. Ginebreda I, Sep 2020

SAT-LB18 A Randomized Controlled Trial of Vosoritide in Children With Achondroplasia. Ginebreda I, May 2020

Once-daily, subcutaneous vosoritide therapy in children with achondroplasia: a randomised, double-blind, phase 3, placebo-controlled, multicentre trial. Ginebreda I. Lancet. 2020 Sep

Lenghthening of the lower limbs and correction of lumbar hyperlordosis in achondroplasia. Human Achondroplasia. Ed. Plenum Publishing Corporation. Nov. 1988.

Lenghthening of lower limbs and correction of lumbar hyperlordosis in acondroplasia. Clinical orthopaedics. 1990. VOL, 250. 143-149. Vilarrubias Guillamet, J.M.; Ginebreda, Martí, I.; Jimeno Torres, E.

Surgical technique and outcomes for bilateral humeral lengthening for achondroplasia: 26-year experience. Ginebreda I. Musculoskelet Surg. 2019 Dec.

WOULD YOU LIKE TO RECEIVE MORE INFORMATION ON LEG LENGTHENING?

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    Dr Ginebreda ICATME

    ICATME – Hospital Universitario Dexeus

    Sabino Arana, 5-19, 2nd floor (Barcelona, Spain)

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