Some patients are looking for certain treatment techniques or methods. I would recommend you find a surgeon who can provide care using all the available relevant techniques. That person is less likely to have a skill bias based on their own ability and will be better placed to give you holistic advice for your specific needs.
The key methods of treatment in limb reconstruction are listed here. I have extensive experience in the most established techniques, as well as access to cutting edge methods of treatment, to improve your experience of the treatment as well as your long term results.
Intra-medullary lengthening (including NuVasive PRECICETM and FitBoneTM )
If you are looking for this you probably already know what you want. For the un-initiated let’s explain.
The bones we use to lengthen limbs are called long bones. These typically have a canal in the middle. It’s a very handy place to put a nice straight rod of metal that can then be used to lengthen the bone so you don’t have to wear a fixator (see below). This makes it easier to get around daily life while you have your treatment, is easier to access and maintain your physiotherapy exercises as well as being easier to come to terms with psychologically.
This technique has been around for a long time but in the last decade we now have access to a very strong very reliable system of nails that have reduced the complication rates massively.
I have been part of the largest published work on the Precice2 system in children and am an internationally recognised expert in this technique.
Some people find that their current height makes life impractical, or simply makes them unhappy. In these cases bone shortening may be an option. Somewhat simpler that bone lengthening as, usually, it is a single event operation per segment. It can be a highly effective procedure in managing the issues around height. There are various methods one can use to hold the bone afterwards including Intra-medullary rods or plates and screws that sit on the bone.
The biggest question really is how much can you shorten. For most people one can safely remove approximately 3m of bone from the Femur (thigh bone) without any complications in terms of knee weakness, cramps or vessel problems. From the Tibia between 2 and 3cm may be possible to shorten in order to avoid weakness of the ankle, calf cramps or nerve/ vessel problems.
I am always happy to meet people interested in this for a consultation to discuss their needs, expectations and help make a plan going forward.
Circular Fixators (Frames)
In many cases an intra-medullary lengthening just won’t be possible. For young children where inserting a nail would necessitate injuring a growth plate and potentially causing huge problems, or in older children and adults who have complex problems near joints, damaged skin and muscle, or severe infection, this is a very powerful method of treatment.
It involves controlling the position of bones in the limb with wires or screws that protrude through the skin and are held on to an external scaffold, called a fixator or a frame. It is an excellent way of controlling complex injuries, getting control of broken but infected bones whilst minimising the amount of metalwork in the site, or correcting highly complex shape problems in bones that would result in complications if done any other way.
As part of an international invitation- only faculty of trainers and expert users I can discuss your options using this technique and the best outcome for your personal circumstances.
Intra-medullary (Trauma) Nails
If you don’t need additional length, sometimes, the slickest and easiest way of straightening a bone and getting you back to walking, working or playing can be to use the same canal in the long bone but put a static solid rod inside. This often means you don’t need a plaster and have no fixator on the outside of the limb, but still achieve your goal. The scars are fairly small and the results usually excellent. It is the same type of rod that can be used for fractures but used here to hold a bone straight after it has been cut.
Plates and Screws
Similar to the Nail concept above, when you don’t need length then these simpler implants are sometimes the best way forward. For malalignments that originate in or near joints (Intra or Peri-articular) or if you don’t want an incision in to a joint to get a nail in the bone, this can be a very powerful method of treatment. Sometimes they can be used in combination with other treatment techniques to simplify or cut down time in a fixator.
Sometimes old is gold and a simple, good old plaster cast applied properly can work wonders, provide excellent pain relief and give excellent results without the need for a big operation. Often used after a bone has been “re-set” it can be used to support a limb or a bone after a bigger operation but this is usually short term for pain relief.
Braces and Splints
These can be excellent methods of management depending on the situation. Usually used after the initially recovery phase or after an operation, sometimes a good brace or splint for a while is all you need.
All the examples given above are personal opinion based on my expertise and the accepted management in our field. However this does not substitute for sound medical advice.
I would encourage any patient wish to discuss your or your child's needs in person prior to making any decisons.