By manually twisting the screws on either end of the fixator, discrete pieces of bone are pulled apart to lengthen legs an average of 1.25 centimeters per day. The body regenerates bone, filling the gap in a matter of hours.
"You gradually stretch out the healing bone sort of like salt water taffy," Blanco says.
Once the desired length has been achieved, Blanco removes the fixator. Months of physical therapy follow. Patients going through any limb-lengthening procedure relearn how to bend their knees, rotate their ankles, walk and swim. If all goes well, the limbs are equal in length and the range of motion is average. Unlucky patients can suffer complications such as multiple fractures, scarring, an off-kilter gait and arthritis as well as hip knee and disc pain.
About 500 limb-lengthening surgeries are performed each year at Sinai Hospital in Baltimore. Doctors there have partnered with Ellipse Technologies to promote the new internal limb-lengthening method. External fixators are invasive, and guarantee postoperative weight loss, inflammation, oozing pustules, and reduced mobility along with the above-mentioned problems. In the best cases a patient treated conventionally can expect to have at least two complications, such as Lindsay's fractured bone, says Debbie Stanitski, an emeritus professor at the Medical University of South Carolina Children’s Hospital.
Precice technology claims to be far less painful and much easier to manage than an external fixator. The newer mechanism relies on rare earth magnets made of an alloy of neodymium iron and boron as well as revolving screw gears to extend a fixator rod that is inserted inside the bone. Doctors direct the gearbox magnetically via a handheld controller, and manipulations occur entirely within the bone, thus minimizing the risk of infection because there are no open wounds. So far, Sinai Hospital has implanted the internal fixator in 31 patients and the initial results look promising. This approach has been much safer than external limb-lengthening methods, reducing the complication rate by 75 percent, says John Herzenberg, director of the International Center for Limb Lengthening at Sinai.
A tough decision
When the Ellingsworths elected to put Lindsay through limb-lengthening surgery, they were aware of the consequences. What they didn't bargain for was how agonizing it would be to watch their little girl suffer through the external fixation process.
Surgically lengthened limbs are never as strong as they were prior to treatment. In Lindsay's case her femur was unable to take the weight of her body and snapped as a result. In order to keep her bone from fracturing again, Lindsay needed the stability of the external fixator's metal frame, which had been removed prematurely. According to the doctor, one of her parents would have to reattach the frame to the screws in her leg—leftovers from an earlier surgery.
Using an Allen wrench, Ellingsworth cinched the fixator's steel bar to screws already deep within Lindsay's bone. For an hour the terrified father tinkered with the brace while Lindsay's mother held her close. Latch the wrench. Dry her tears. Twist the wrench. Listen to her screams. Repeat. When it was over, Ellingsworth embraced his child tightly and wished he could take some of the burden off her small shoulders. Lindsay was only eight years old, and this was just the first surgery with many to follow. Legs can only stretch about 12.7 centimeters at a time so patients must come in for multiple operations.
"They'll spend the rest of their life being lengthened," says Doreen DiPasquale, a reconstructive orthopedic surgeon at Sharp Memorial Hospital in San Diego, Calif. "That's not fair to the kid...It's a quality-of-life issue."