Bone Grafting - Can any one help me Plz...

[murthy]

Hi everybody, my name is KLN Murthy.

Last year I met with an bike accident..It's already 1 year ago and doctors have conducted 2 surgeries to my right leg and done BONE GRAFTING couple of times. Now I am with ILLIZAROV rings and trying to walk without sticks as per doctors advice.

Now my worry is that my right leg is little bit shorter than my left leg. So anybody can advise me whether there are any exercises, so that shortage can be rectified.

You can mail me to [email protected] also.
I can mail some more details to you if anybody required of the two surgeries, conducted for my leg.

I will be very grateful to all physios.... and I hope I will get reply from you guys.. Once again, Thanks in advance..

Thanks & Regards,
KLN Murthy.

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[morwenna]

There are NO exercises that will lengthen your leg. If you have finished growing then your leg is the length it is. Period.

There is a possibility that your leg is not actually shorter, but an apparent discrepancy due to pelvic obliquity etc, but this is unlikely in your case, from your history as given.

Many people have up to half an inch (or 1 cm+) shortening all their life with no symptoms. The spine curves slightly sideways and the body adapts, but if there is a larger difference this can lead to back pain and other problems.

Get somebody who knows what they are doing to measure your leg lengths, "real" and "apparent". If there is a small difference and you are bothered by it, try a 1/2 cm heel raise inside your shoe to see if that helps.

If that is not sufficient you may need to have an external heel and sole raise applied to your shoe. One generally raises the heel by about 1/2 cm more than the sole. You can't put a big heel raise in and still expect your shoes to support you, and anything over 1/2 - 3/4 cm raise you should have a slightly smaller fore-foot raise as well.

Incidentally, we had a 40 something lady in our clinic last week with a 19cm short leg!!! She said she'd tried a shoe raise, but it got in the way on stairs as she had a fixed knee and limited hip movement!

.... and anyway, she said, it was sometimes useful to be two different heights!!

[murthy]

Hi everybody,

Last year I met with an bike accident..It's already 1 year ago and
doctors have conducted 2 surgeries to my right leg and done BONE
GRAFTING couple of times. Still I am with ILLIZAROV rings and trying to
walk without sticks as per doctor's advice. According to the doctor,
these ILLIZAROV rings may be removed in February Last week, and after
removing those rings, It's required for me to have an artificial
external support(with cement).


Now my worry is that after that accident, my right leg become little bit
shorter than my left leg. So anybody can advise me whether there are any
exercises, so that shortage can be rectified.

And... what kind of exercises I can do after removal of ILLIZAROV rings?
And... Upto which extent I can bend my knee.. Is it really depends on physiotherapy?

I can mail some more details to you if anybody required of the two
surgeries, conducted for my leg.

I will be very grateful to all physios.... Thanks in advance..

Regards/KLN Murthy.

[physiobob]

Hi Murthy,

Sounds like you did a good job if you needed this type of external fixation. I have had several clients who have had this type of fracture stabilization and one actually for a lengthening procedure of a short leg. (they broke the leg and fixed it while each week lengthening the rings apart about 1mm for about 18 months).

There are no exercises that will lengthen the leg. If there is still a true length discrepancy at the end of the rehabilitation period then it is possible with this type of stabilization to perform a lengthening again. But you might not be up for that hassle for another 18 months.

I suppose we need more information of what was broken and where. Any images you could post of the x-rays would be great. Exercises will e pretty simple to begin with and weight bearing is very important to accelerate bone re-ossification around the fractures. So try to get some weight onto the leg to achieve a better result.

Look fwd to hearing more details from you shortly.

Attached is an image of ILIZAROV rings for people who are not sure what you are talking about

[murthy]

Dear Sir,

Thank you for your reply.
I am trying to scan the X-Ray copies to send it to you for your further reference.

However, I am giving you some information about those surgeries by date wise. (Pl find herewith attached word doc. file)

I believe it is too big description and it will kill your precious time..
My request to you is please go through the below info.

Once again I would like to Thank You and I am sorry for taking out your precious time.

Thanks & Regards,
KLN Murthy.

NAME: K.L.N.MURTHY, MALE, 29 YEARS

DATE:31/01/2007

CLINICAL EXAMINATION:-

Laceration wound of size 20 cm.
Extending from medial to lateral side of right knee.
Expand knee joints patella with avulsion of patella tendon.
2 puncture would over the middle 1/3 of right leg.
Lacerated wound extending from base of 2nd toe to the ----- of 5th toe.
Gross abnormal mobility leg at middle 1/3 of right tibia.
posterior tibial artery palpable.

X-RAY CERVICAL SPINE AP AND LATERAL VIEW :-

Cervature of spine lost.
C6 and C7 vertebrae not included in lateral view.
On AP view ? partial fusion C6 and C7 vertebrae laterally on the right (?Block vertebra).
Rest of the vertebral bodies appear normal.
IV disc spaces are normal.
Posterior elements normal.

X-RAY RIGHT ANKLE AP AND LATERAL VIEW:-

Bones are normal in density and alignment.
Epiphyseal centers are normal.
No evidence of osteolytic/sclerotic lesion.
No evidence of bony injury.
Soft tissue planes are maintained,
Evidence of internal fixation noted.

X-RAY RIGHT FOOT AP AND OBLIQUE VIEW:-

Suspicion of subtle cortical lucencies at the base of the 4th, 5th metatarsal bones - ? fracture.
visualized joint spaces are well maintained.
Rest of the soft tissues appears normal.

RIGHT KNEE JOINT AP & LAT VIEW:-

Communated fracture upper third of the right tibia.
Fracture upper third of the right fibula.
Evidence of internal fixation noted.

DETAILS OF SURGERY:-

Under aseptic condition through saline irrigation of wound and debridement done/peroperative.

Findings:- Degloving of skin upper 2/3 right leg anteriorly.
Exposed communited tibia from just below articular surface to mid third tibia.
Vertical fracture patella with communited loose fragments of lateral part of patella.
Avulsed patella tendon.
Exposed right knee joint and patella.
skin defect of upper 2/3 leg right.
Multiple lacerated wounds on foot.

PROCEDURE DONE:-

External fixation of right leg extending from lower thigh to lower third leg.
Schanz pins applied in femur and 5 pins applied in tibia.
All pins connected to rod with clamps.
Irrigation of wound and debridement of necrotic tissue done.
Medial gastrochemices and medial soleus elevated used to cover the defect on 2/3 tibia.
SSG harvested from left thigh and applied over muscle flaps.
Repair of patellar tendon.
Debridement and primary closure of wounds over the foot.

DATE: - 17/04/2007

(AT THE TIME OF 2ND SURGERY

FINAL DIAGNOSIS: - 8 Weeks old Grade III B open fracture both bones
of right leg.

CHIEF COMPLAINTS:- Admitted for tubular external fixation and Ilizarov ring fixation application and skin grafting.

Local Examination:-

Bi planar tubular external fixation in situ.
Old healed scar of flap present.
Gap palpable over the fracture site.
Movement at ankle restricted.


DATE: - 26/07/07

DETAILS OF SURGERY:-

Under aseptic condions, Under spinal Anesthesia, In supine position,
Ilizarov's pin and rings were removed.
New Ilizarov's wires are inserted according to pre planned ring adjustments.
2 rings proximal to fracture site.
2 rings distal to fracture site.
Wires fixed to rings and tensioning done.
Bone graft taken from left Iliac crest and grafting done along with medial aspect of the fracture site.
Fracture site fibrous tissue not disturbed.
Wound closed in layers.
After securing hemostasis, ASD done.

[murthy]

Hi Mr. Physiobob,

Pl find herewith attached some X-Ray copies by date wise for your reference.

Thanks & Regards,
KLN Murthy.

[murthy]

Sir,

Did you find my post??

Regards/KLN Murthy.

[physiobob]

Wow!!! You certainly did a good job. I see from the xrays that these coder two periods, the most recent being in Dec 2007. Perhaps that was after the second grafting.

To be honest I think the surgeons have done a poor job, or that the fixation is not holding. There seems to have been movement in the bones since the earlier images and the alignment is way off. Not sure how one wants to get bone union when the bones are not in a placement to encourage them joining together.

I am sorry to be so blunt and negative but if I were in your shoes I would be looking for another orthopaedic opinion asap. Have you any facility to seek treatment in another country?