LIMB RECONSTRUCTION SURGERY

What is Limb Reconstruction Surgery?

Limb reconstruction surgery (LRS) is a discipline which deals with problems of shortening, angular deformity, angular deformity combined with shortening, bone and / or soft tissue loss and restores the anatomy and more importantly the function of the limb. Though LRS is a sub-specialty of orthopedic surgery, it is considered as a super-specialty as it requires dedicated orthopedic surgeons working as a team with multidisciplinary expertise in various techniques of orthopedics either used separately or in combination to lengthen, replace, realign and stabilize joints in order to improve the function of the limb.

Which conditions require LRS?

The orthopedic conditions that require LRS can be divided into congenital and acquired. The congenital deformities include clubfoot, achondroplasia, fibrous dysplasia, hemimelia and pseudoarthrosis. Developmental disorders can also be included in this group. The acquired conditions that can be treated with LRS are post traumatic infections of the bone (Osteomyelitis), tumors, complications and failures of previous surgeries. Simple deformities can simply be corrected by cutting the bone, aligning it properly and fixing the bone with plate, screws or nail, whereas complex deformities require a gradual correction with external fixators.

What is an external fixator and what are the different types available?

An external fixator is a metal frame which is assembled and fixed as an external framework with wires and pins. It is like a scaffold for an under construction building. There are several types of external fixators like Ilizarov Ring Fixator and Orthofix.

1. Ilizarov Ring Fixator - The Ilizarov system uses a series of rings with interconnecting telescoping rods to correct the deformity by using techniques like docking and distraction osteogenesis to correct and lengthen the bone. It is also useful in mangled extremities and can be used across joints.

2. Orthofix - The Orthofix is a modular system which has been specifically designed to enable a surgeon to perform a single level or multiple level surgical deformity correction.

What are the various case studies requiring LRS?

1. Limb length discrepancy - They are more often due to congenital disorders, poliomyelitis or traumatic disorders. It takes of lot of planning and several staged surgeries with a monolateral frame like Orthofix or with an Ilizarov fixator to correct these deformities. Techniques like bone transport, distraction osteogenesis and soft tissue procedures like tendon transfers and grafting are often involved.

2. Skeletal dysplasias - These can be corrected by growth modulation techniques in children or osteotomies in adults. 3. Bone deficit and Non Union - These can be managed by bone transport and bone grafting techniques. 4. Bone infections - Infected bone requires to be thoroughly debrided and all the dead bone needs to be excised. The second stage uses bone grafting and application of an external fixator for stability. 5. Neoplasms - Radical excision of tumors and reconstruction using either cadaverous bone or autologous bone transport in conjunction with limb

preserving systems that are currently available has diminished the need to amputate the affected limb. The recently available limb reconstruction systems can be satisfactorily used to replace a joint or a bone partially or in total. Thus the LRS has become a mainstay to avoid amputations.

Dr. Sai Laxman Anne

Chief Consultant Orthopaedic and Joint Replacement Surgeon

KIMS Hospitals, Kondapur

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