Treatment Strategies

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A residual limb may be lengthened to improve prosthetic wear and function. This includes above-knee amputation, below-knee amputation, foot amputation, above-elbow amputation, and below-elbow amputation, including bilateral cases.

An external device is surgically attached to the residual limb and the bone segment is cut. The external fixator is then adjusted in small increments on a daily basis to gradually distract the bone and soft tissues. Depending on the particular bone and health of the surrounding soft tissues, the residual limb may be lengthened between 0.5 to 1.0 mm per day until the desired length is obtained. This is called the distraction phase. After the lengthening has been completed, the fixator is no longer adjusted and the patient enters the consolidation phase whereby the distracted bone heals back to normal strength.

Skill, daily physical therapy is an integral part of the treatment program for limb lengthening. As such, our patients are required to stay in West Palm Beach throughout the lengthening phase and to attend daily physical therapy. When the patient enters the consolidation phase they are allowed to return home to continue physical therapy and will return monthly for clinical exam and x-rays. Typically, the consolidation time is 1 to 2 times the duration as the distraction time. The patient will have limited weight bearing and will not be able to wear their typical prosthetic due to the presence of the external fixator. At the end of consolidation, the patient returns to our center for fixator removal.

Lengthening of the residual stumps greatly improves prosthetic fitting and function, as demonstrated below on a patient who previously underwent bilateral stump lengthening for above-the-knee amputations of both legs: