Name of the Procedure:

Osteoplasty, radius OR ulna; lengthening with autograft (Bone Lengthening Surgery)

Summary

Osteoplasty with lengthening involves surgically extending the length of either the radius or ulna bone in the forearm, using a piece of the patient’s own bone (autograft) to achieve the desired results.

Purpose

This procedure is typically performed to correct limb length discrepancies or deformities, improve functional outcomes, and enhance the patient's quality of life by restoring the proper length and alignment of the radius or ulna.

Indications

• Significant forearm length discrepancies
• Congenital bone deficiencies
• Post-traumatic bone defects or shortening
• Non-union or malunion of forearm fractures
• Avascular necrosis of one of the forearm bones

Patient criteria for this procedure often include:

• Adequate general health to undergo surgery
• Specific diagnostic imaging confirming the need for lengthening
• Failure of conservative treatment options

Preparation

• Pre-procedure physical examination and medical history review
• Diagnostic imaging (X-ray, MRI, or CT scan)
• Blood tests and possibly a pre-surgical clearance from a primary care physician
• Fasting typically required for 8-12 hours prior to surgery
• Adjustments to current medications as advised by the surgeon

Procedure Description

1. The patient is brought to the operating room and given general anesthesia.
2. The surgeon makes an incision over the area where the bone will be lengthened.
3. A segment of the radius or ulna is carefully cut.
4. An autograft (a piece of bone taken usually from the patient’s pelvis) is prepared and placed between the cut segments.
5. The autograft is secured in place using surgical plates, screws, or external fixation devices.
6. The incision is closed with sutures, and a sterile dressing is applied.

Tools and equipment used include surgical saws, bone grafting instruments, fixation devices (plates, screws, or external fixators), and sterile dressings.

Duration

The procedure typically takes 2-4 hours.

Setting

Performed in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Surgical technologist

Risks and Complications

• Infection
• Bleeding
• Nerve or blood vessel damage
• Non-union or delayed union of the bone
• Complications from anesthesia
• Chronic pain
• Hardware failure or complications

Benefits

• Correction of limb length discrepancy
• Improved limb function and range of motion
• Enhanced cosmetic appearance
• Possible relief from pain associated with bone defects or deformities

Expected benefits can be realized several months following surgery as the bone heals and strengthens.

Recovery

• Post-operative immobilization of the limb, often in a cast or brace
• Pain management with prescribed medications
• Physical therapy to regain mobility and strength
• Regular follow-up appointments to monitor healing
• Gradual return to daily activities, typically over a period of 6-12 months
• Avoiding heavy lifting or strenuous activities during recovery

Alternatives

• Orthotics or shoe lifts for minor discrepancies
• Physical therapy and rehabilitation
• Limb lengthening using external fixators without autograft
• Amputation and prosthesis (in extreme cases)

Each alternative has pros and cons, and the choice depends on the specific condition and patient needs.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel any pain. Following surgery, pain and discomfort are to be expected but managed through prescribed pain medications. Patients may initially experience immobility and dependence on assistive devices. Emotional and physical support during the rehabilitation phase can aid in recovery and improve overall outcomes.