The “Holyfix” method is a monolateral rod type method that has been used in success since 1997. This method involves limb lengthening to be achieved with an external fixator without any internal bone support. Monolateral external fixators are attached by pins to the patient’s legs. The nails are attached to the nearest and safest area, especially not near any vein and nerve. The chances of open wound infection is very small.
Holyfix apparatus is made of a special, aluminum and titanium alloy, thus lighter in weight and is MRI and radiology compatible. Hence, making this biomechanical system extremely stable and safe; allowing the patient to walk during the treatment phase. This device makes the distraction (bone lengthening) process very practical and easy, allowing the patient to perform extensions on their own. In addition, Holyfix apparatus has such a superior design that it allows for accelerated bone formation and transfers the burden from the bone without any shortening (Dynamization).
What are External Fixators?
External fixators are metal devices that are attached to the bones of the arm, leg or foot with threaded pins or wires. These threaded pins or wires pass through the skin and muscles and are inserted into the bone. The majority of the device is outside of the body, which is why it is called an external fixator. Many people only require one external fixator to be applied, but some will need two or more external fixators.
About Iranian Surgery
Iranian surgery is an online medical tourism platform where you can find the best orthopedic Surgeons in Iran. The price of Leg lengthening Surgery in Iran can vary according to each individual’s case and will be determined based on photos and an in-person assessment with the doctor.
For more information about the cost of Leg Lengthening Surgery in Iran and to schedule an appointment in advance, you can contact Iranian Surgery consultants via WhatsApp number +98 901 929 0946. This service is completely free.
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Before Limb Lengthening Surgery by Holyfix Method
When are external fixators used?
External fixators can be used to gradually lengthen a bone, straighten a deformed bone or reduce pressure on a joint through joint distraction.
How to Prepare
The surgical team will provide you with more detailed instructions on what you need to do in the days and hours before the surgery. It is recommended that you stay active, eat a healthy diet, and stop smoking prior to any operation to promote optimal healing and a smooth recovery.
You may need to stop taking certain medications in the days leading up to the surgery to prevent excess bleeding or interaction with anesthesia during the operation. Always consult with your doctor about all prescriptions, over-the-counter medications, and supplements that you are taking.
After the operation, you will typically stay in the hospital for two to three days. You will not be allowed to drive to or from the hospital before or after your surgery, so make sure to make arrangements for a friend or family member to provide transportation for you.
Minimizing stress and prioritizing good mental and emotional health are also important to lowering levels of inflammation in the body to aid in your recovery. The healthier you are when you go into surgery, the easier your recovery and rehabilitation will be.
What to Expect
Limb Lengthening Surgery-External Fixators will be a procedure decided between you and your doctor and will be scheduled in advance depending on the availability of your surgeon and the operating room.
Before the Surgery
On the day of your Limb Lengthening Surgery-External Fixators, you will be taken to a pre-op room where you will be asked to change into a gown. You will undergo a brief physical examination and answer questions about your medical history from the surgical team. You will lie down on a hospital bed, and a nurse will place an IV in your arm or hand for delivering fluids and medications. The surgical team will use the hospital bed to transport you in and out of the operating room.
Limb Lengthening Surgery-External Fixators helps correct significant limb length discrepancies, but it carries a number of risks, including:
. Bone infection (osteomyelitis)
. Poor bone healing
. Bone growth restriction
. Nerve damage
. Injury to surrounding muscles and blood vessels
. Excess bleeding
. Adverse reaction to anesthesia
. Blood clots
. Nausea and vomiting
. Joint stiffness
. Bone length may not be exact, such as longer or shorter than planned
. Muscle contraction (muscle shortens)
. Problems with the new bone forming
Always discuss with your doctor about the possible risks of Limb Lengthening Surgery-External Fixators to determine if it is an appropriate option for you given the extent of your limb length discrepancy and how it is affecting your daily functioning.
What are pin-site infections?
Pin-site infections are the most common problem associated with external fixation treatment. Pin-site infections begin at the level of the skin. If identified early, they are easily treated. If left untreated, they may progress to the deeper soft tissues and possibly even to the bone.
It is important for the patient or family to know the symptoms of a pin-site infection. The most common symptoms are tenderness in an area around a pin site that was not previously tender and increased redness at the pin site. Sometimes the area will have increased warmth, swelling, pain or drainage compared to the other pin sites.
When patients with external fixation leave the hospital, the doctor will give them a prescription for oral antibiotics. If patients develop the signs of a pin-site infection, they should fill the prescription and immediately begin to take the oral antibiotics. It is important to start the antibiotics quickly (within 24 hours). The patient/family does not need to call the office to confirm that the patient has a pin-site infection before the patient starts taking the oral antibiotics. Once the antibiotics are started, call us within 24 hours to let us know that you are treating a pin-site infection. The redness, tenderness and drainage should improve within 24 to 48 hours of starting the antibiotics.
The risk of a more serious infection (i.e., toxic shock syndrome or necrotizing fasciitis) that can be life-threatening is extremely rare.
The signs of a more serious infection are pin-site pain along with one or more of the following symptoms:
. Vomiting, and/or
. Appearing glassy-eyed, pale or flushed.
If the patient has any of these symptoms, we need to know urgently; contact your doctor or the doctor on call. Again, these types of infection are rare; however, if they occur, treatment is straightforward but must be started immediately. The treatment normally requires a trip to an emergency room and a dose of IV antibiotics for 24 hours.
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Purpose of Limb Lengthening Surgery-External Fixators
Many patients who are candidates for limb lengthening surgery have two legs/arms of different lengths as the result of:
. A congenital birth defect
. Growth plate injury to a leg/arm bone as a child
. Malunion of a previous fracture where the leg/arm bone heals out of alignment
. Nonunion of a previous fracture where the leg/arm bone does not heal at all
Patients with skeletal dysplasias or other bone disorders may also qualify for limb lengthening surgery if there is a significant difference in leg/arm lengths between the right and left sides, affecting their ability to walk and move properly.
Other conditions that can cause a significant limb length discrepancy requiring limb lengthening surgery include:
. Cerebral palsy
. Legg-Calve-Perthes disease
If you suspect you have a limb length discrepancy, you should receive a physical examination from an orthopedic physician to determine if there is a true limb length discrepancy due to different leg/arm bone lengths or if there is an apparent limb length discrepancy where one leg/arm appears to be shorter even though both leg/arm bones are the same length.
Apparent limb length discrepancies can result from problems with the spine, hips, or sacroiliac joints. Physical therapy is often effective for restoring proper alignment of the muscles and joints to correct the issue. If your doctor suspects you may have a true limb length discrepancy, x-rays will be used to confirm the difference in bone length.
During Limb Lengthening Surgery by Holyfix Method
During the procedure
Arm or leg extensions:
If the length of bone is extended to 5 cm, one level, it is extended over 5 cm, two-level cuts are surgically made. Two or three nails are applied to both sides of the area. This is mainly dependent on the body weight (BMI) of the patient. Henceforth, a suitable “HolyFix” fixator is prepared and applied.
During the surgery, an incision is made on the skin section about 3 to 4 cm. Monolateral external fixators are attached by pins to the patient’s legs. The nails are attached to the nearest and safest area, especially not near any vein and nerve. Single-zone single arm-leg lengthening surgery takes an average of 40 minutes; arm-leg lengthening takes about 60 minutes. The operation is performed under either general anesthesia or spinal anesthesia.
Monolateral External Fixators
Monolateral external fixators have a straight bar that is placed on one side of the arm, leg or foot. It is connected to the bone by screws that are often coated with hydroxyapatite to improve the screws’ “hold” in the bone and prevent loosening. The patient (or family member) may need to adjust the device several times a day by turning knobs.
Height lengthening is a process where both legs are extended. Whereby, both the legs are lengthened at the same time, thus the patient’s height is increased, simultaneously. Limb Lengthening Surgery by Holyfix Methodology, generally, take about 90 minutes for a single level (up to 5 cm), 2-2.5 hours for a double level (up to 10 cm).
Normally, this process of lengthening starts at the hospital. The lengthening is a total of 1 mm per day in four equal parts (4 × 0.25 mm) at each lengthening level.
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After Limb Lengthening Surgery by Holyfix Method
What happens after the external fixator is applied?
If the patient’s arm or leg is lengthened, they would have to reside at the hospital for 2 to 3 days; In case, of stature or both leg lengthening is achieved, their stays would last between 5 to 7 days. During this period, the patients are informed about the treatment and the lengthening process, in total. Walking with crutches and nail care and maintenance is thoroughly taught. Physiotherapy training is taught and practiced.
After surgery, the bones are allowed to rest for 5 to 7 days to begin the healing process. After this period of time, the distraction phase of treatment begins. The patient (or family member) will be given a schedule that instructs them how to adjust the fixator several times a day by turning small knobs or other parts of the device to slowly pull the bone segments apart.
This gradual process of slowly separating the bone segments is called distraction, which means “pulling apart.” As the bone segments are pulled apart at a slow rate of approximately 1 mm (0.04 inches) per day, new bone forms in the space between them. The new bone is called regenerate bone. The distraction phase lasts until the bone is straight or corrected. The patient will need to see the doctor every 10 to 14 days during the distraction phase.
After the correction has been achieved, the consolidation phase begins in which the regenerate bone slowly hardens. During this phase of treatment, the external fixator normally remains in place so that it can support the bone as it heals. The bone has consolidated (“healed”) when the regenerate bone has completely hardened and calcified.
The consolidation phase typical takes twice as long as the distraction phase. For example, if distraction is completed in 1 month, then consolidation will take 2 months.
To help the bone heal, patients should avoid nicotine in any form, make sure that their diet includes lots of protein and take vitamin and mineral supplements. During the consolidation phase, your doctor may tell you to start putting some weight on the arm/leg, which will also encourage the bone to harden and heal.
After the bone is fully consolidated, the external fixator can be removed during an outpatient surgical procedure (the patient does not stay in the hospital overnight after the removal procedure). To provide additional protection for the new bone, our doctors may apply a cast or ask the patient to use a brace for 3 to 4 weeks after the external fixator is removed.
The main drawback for many patients is the long period spent with external fixators: these devices can be removed only after full consolidation of bones (which takes around 9-12 months).
Long walks, heavy exercises and sports are generally prohibited, until the time that the bones have fully recovered to normality, after the removal of the devices. However, ample swimming is a recommended exercise. Generally, most physical activities are allowed, as long as the bones are of the same quality and integrity to the other bones, of the patient.
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