Most broken bones can be put back together using methods like splints, casts, and implanted screws and plates. But what happens when a bone is so badly damaged that large portions can’t be saved?
Depending on the situation and the extent of the soft tissue damage, the patient might have a choice of artificial joint implants, or amputation might be the only option. However, when a bone is severely damaged in the middle, instead of at a joint, there’s one treatment that can allow some patients to recover completely, by re-growing their lost bone mass and length.
Unfortunately, limb lengthening is difficult, expensive, and carries some undue stigma that may prevent trauma survivors from receiving the care they need, especially when they find themselves in the position of having to justify that need in court.
The Stoddard Firm proudly helps people who have been severely injured by someone else’s negligence obtain the help they need to pursue the best possible care.
Limb Lengthening Allows Patients to Grow Back Destroyed Sections of Bone
Limb lengthening is a surgical treatment used to repair limbs that have had sections of bone removed due to infection or extremely complex breaks. It can also be used in some situations to address uneven or unusually short limbs caused by illnesses and congenital disorders, and it has recently gained popularity as an elective procedure.
It works on a principle sometimes referred to as callotasis, callus distraction, osteodistraction, or distraction osteogenesis. In simple terms, the process goes something like this:
- If the bone to be lengthened is in one piece to begin with, the surgeon will neatly break in in two. If the bone is already in multiple pieces, or part of it has been overtaken by infection or cancer, the surgeon removes the unsalvageable parts until there are two healthy ends of bone remaining.
- The surgeon then aligns and presses together the two healthy ends of bone, and installs a device that will later be used in the lengthening process. This device is usually what’s known as an external fixator. An external fixator screws into the healthy bone through the skin and muscle, connecting it to a framework outside the patient’s body.
- After the initial operation, the fixator holds the bones together, just long enough for a callus of new bone to grow and connect them. This usually takes about 7-10 days.
- Instead of keeping the ends of the bone together and immobile, as one would to repair a typical break, the patient or caregiver then begins adjusting the external fixator to pull or “distract” the ends apart, encouraging the bone callus to grow in length. Most patients can expect to gain about a millimeter of bone length per day, for a period of two to three months, while the callus is strong enough to withstand distraction but not yet fixed.
- After the bone has reached the desired length, or as close as it will get through a single course of lengthening, it takes another two to four months for the callus to fix and harden, returning the limb to its original strength. A physical therapist works with the patient to rehabilitate the limb gradually through exercise. If the limb being lengthened is a leg, crutches are necessary during this period.
- When the limb has reached full strength, the internal screws are removed in an additional operation.
Although painful at the time, limb-lengthening usually does not usually have long-term side effects. For survivors of accidents and violence, a course of limb-lengthening can sometimes mean the difference between permanent disability and a full recovery.
New, Internal Lengthening Devices Can Make the Process Safer and Faster
The use of osteodistraction to lengthen limbs was pioneered in 1950s Russia, and until recently, the process had remained largely unchanged since then. New advancements have focused on reducing or eliminating the amount of time patients must spend wearing an external fixator.
External fixators are still in use today, but they’re awkward to wear and carry a significant risk of infection. Remote-controlled limb lengtheners, first approved by the FDA in 2012, aim to solve this problem. They can be implanted inside the limb with no protruding hardware, eliminating points of entry for bacteria and allowing patients to wear their choice of clothes during treatment.
Currently, internal limb lengtheners are usually used in conjunction with external fixators, but they make it possible to remove the external fixator sooner, while achieving equal or better results. Over the course of a few years in the 2010s, both methods were used to help an Arkansas woman with a painful form of dwarfism gain about a foot of height, enabling her to drive an unmodified car, use a public sink, and walk without joint problems.
Unfortunately, as with many new medical technologies, the safer, newer version carries an even heftier price tag, leaving patients’ level of care to be determined by insurance companies and — in the case of negligence victims — court rulings.
Limb Lengthening Can Save Limbs and Restore Mobility
For appropriate candidates, reconstructive limb lengthening offers an excellent chance of a full recovery and high quality of life. One study, published by the University of Amsterdam in 2009, found that patients who’d undergone limb lengthening to treat trauma-related bone loss reported little functional difficulty nine years later. In most ways, the patient’s self-assessment answers were comparable with those of people who had never suffered similar trauma at all.
Another study, published in 2013 by the Journal of Trauma Management and Outcomes, examined the immediate results for 36 trauma patients, half of them motorcycle accident survivors, who underwent limb lengthening to regrow lost sections of femur or tibia. Of them, 30 were able to recover their original leg length completely with no serious complications, and 3 more were able to regain enough length to make up the difference with raised shoes. The remaining 3 chose to pursue further treatment, either locally or overseas, after the study was over.
Nowadays, some providers estimate the first-round success rate for limb lengthening to be even higher than that 2013 study suggests, perhaps as high as 95%. Those are pretty great odds, especially considering the potential consequences of leaving bone loss untreated.
Physically compensating for a shortened limb can put problematic new stresses on the body that take a toll over time. As a result, trauma survivors who lose bone length and never recover it may be at risk for:
- Chronic pain, especially in the back, hips, and legs
- Functional scoliosis
- Herniated discs
- Plantar fasciitis
- Osteoarthritis of the knee, hip, and lumbar spine
- Accidental falls, leading to further injury
Limb length discrepancy can also make it difficult or impossible to participate in beloved physical hobbies, which is a major motivating factor for many patients when seeking treatment. The Hospital for Special Surgery in New York tells prospective patients about one particularly active woman who pursued limb lengthening after a rollerblading accident left her unable to enjoy her usual lifestyle. Within a year of beginning treatment, she was rollerblading again.
In some cases, limb lengthening can even be a vital tool in the process of salvaging a limb that would otherwise have to be amputated. In 2013, an English journalist experienced a PTSD-related blackout and jumped off of a wall five meters high, sustaining multiple complex compound fractures in his left leg. When he arrived at the hospital, there was only one living capillary connecting his leg to the rest of his circulatory system. Over the course of 10 surgeries, doctors were able to use osteodistraction, combined with a muscle transplant, to not only save his leg but restore his ability to walk.
In short, limb lengthening can make a profound difference in patients’ lives that cannot be replicated with any other procedure. Any patient who stands to benefit from it should be free to make that decision, with the help of their care provider, without having to worry about whether they can secure coverage from the person whose negligence hurt them in the first place.
The Craze of Cosmetic Limb Lengthening May Make It Harder for Survivors to Get the Help They Need
One of the obstacles trauma survivors are facing when trying to access limb lengthening care is the stigma caused by the recent trend of cosmetic osteodistraction.
In the U.S and the U.K, wealthy men (and a few women) of average or moderately below-average height have begun paying for osteodistraction surgery to make them taller, believing it will make them more attractive or respected. At one facility in Las Vegas, the procedure costs a total of $76,000, as of 2018, and yields results of about three inches. In the east, particularly India, the practice is much more common, for women as well as men, and much less regulated.
The safety, value, and advisability of cosmetic surgery under various circumstances ought to be a separate issue, irrelevant to the cases of trauma survivors in need of reconstructive and limb-salvage procedures. Unfortunately, once a procedure becomes popular cosmetically, it tends to become associated with frivolity and vanity in the public consciousness.
Consequently, jurors (and insurance providers) may assume that a survivor is requesting limb lengthening purely for self-image reasons, not realizing how important it is to their health, safety, mobility, and overall quality of life.
The Need for Limb Lengthening Can Be Challenging to Explain to a Lay Audience
Limb lengthening is a complex procedure, and for trauma survivors, it’s often interdependent on other necessary reconstructive care. Getting coverage for an expensive, intricate, and publicly misunderstood medical procedure is almost always difficult, even when personal insurance should theoretically cover it. Insurers will frequently try to argue that care isn’t necessary, or that a cheaper procedure should be substituted, against the patient’s best interests. However, if there’s a chance that the patient can get coverage from somewhere else — for example, if the injury occurred in a traffic accident that was someone else’s fault — a personal insurance company will typically refuse coverage entirely.
In these situations, litigation may be a survivor’s only avenue for accessing the care they need, and it comes with its own challenges. Instead of just struggling with one insurance company, survivors who pursue legal action have to convince a judge and a jury of laypeople that limb lengthening is what they need. Meanwhile, counsel for the person or company who caused the injury will be doing everything possible to discredit the survivor.
For a victim of negligence, the path to recovery and justice can be intensely stressful and fraught with obstacles, and no one should have to walk it alone.
The Stoddard Firm Can Help Survivors Win Coverage for This Life-Changing Procedure
If you’ve suffered bone loss due to a traumatic injury that was someone else’s fault, and your care provider has recommended limb lengthening treatment to restore maximum function and comfort to you body, The Stoddard Firm can help you get the compensation you need to fund a full recovery.
We’re experienced in educating juries and judges on complex injuries and procedures, including limb lengthening, leading to fair rulings that give survivors the means they need to heal and put their lives back in order. We’ll establish what caused your accident, what the defendant should have done to prevent it, what limb lengthening is for, and why there’s no substitute for it. We’ll also make your pain heard and understood, so that your final settlement appropriately reflects it.
To get started with a free consultation on your individual case, just reach out through our online chat function, or give us a call at 678-RESULT.