Name of the Procedure:

Osteoplasty, Tibia and Fibula, Lengthening or Shortening

Summary

Osteoplasty of the tibia and fibula involves surgical alteration of the long bones in the lower leg to either lengthen or shorten them. This procedure is often done to correct differences in leg length, deformities, or other orthopedic issues.

Purpose

• Medical Condition or Problem: Leg length discrepancies, congenital deformities, post-traumatic deformities, and some cases of dwarfism.
• Goals/Outcomes: To achieve equal leg lengths, correct bone deformities, improve gait and function, and alleviate associated discomfort or pain.

Indications

• Significant difference in leg lengths causing discomfort or difficulty walking.
• Congenital deformities affecting the tibia or fibula.
• Post-traumatic deformities resulting from previous injuries.
• Specific types of dwarfism requiring leg lengthening.

Preparation

• Pre-procedure instructions might include fasting for a specific period.
• Medication adjustments may be necessary, especially for blood thinners.
• Diagnostic tests such as X-rays, MRIs, or CT scans to assess bone structure and plan the surgery.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure patient comfort.
2. Incision: A surgical incision is made over the tibia or fibula.
3. Bone Cutting: A controlled cut (osteotomy) is made in the bone.
4. Lengthening or Shortening:
   • For lengthening, an external or internal device is used to gradually pull the bone segments apart, allowing new bone to form in the gap.
   • For shortening, a segment of bone is removed and the ends are realigned and fixed with plates, screws, or rods.
5. Fixation: The bone is stabilized using medical devices like external fixators, internal rods, or plates.
6. Closure: The incision is closed with sutures or staples.

Duration

The surgical procedure typically takes 2 to 4 hours, depending on the complexity.

Setting

The procedure is performed in a hospital or surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Support staff

Risks and Complications

• Infection
• Blood clots
• Nerve damage
• Delayed bone healing
• Hardware failure
• Uneven bone growth in pediatric patients
• Pain and swelling

Benefits

• Corrects leg length discrepancies.
• Improves walking ability and gait.
• Reduces discomfort and pain associated with leg length differences.
• Enhances overall quality of life.

Recovery

• Immediate post-operative care includes pain management, wound care, and monitoring for complications.
• Physical therapy is crucial and typically starts soon after surgery.
• Recovery time varies but generally ranges from several months to a year, depending on whether the bone was lengthened or shortened and the patient’s overall health.
• Follow-up appointments are essential to monitor bone healing and adjust any external devices if used.

Alternatives

• Shoe lifts or orthotic devices for minor leg length discrepancies.
• Non-surgical physical therapy and exercises.
• Epiphysiodesis (growth plate surgery) in growing children.
• Each alternative has specific pros and cons, often balancing the invasiveness and permanence of the surgical option with convenience and comfort.

Patient Experience

• During the procedure, the patient will be under general anesthesia and will not feel anything.
• Post-procedure, patients may experience pain, swelling, and discomfort managed through medication.
• A period of limited activity and the use of crutches or a wheelchair may be necessary.
• Gradual return to full activity levels with ongoing physical therapy.

This markdown text provides a comprehensive overview of the osteoplasty procedure, ensuring that patients and healthcare providers can easily access and understand the essential information.