Surgical treatment

Pediatric dwarfism clinic

Surgical Treatment

A.  Ilizarov apparatus is an external fixation device that involves inserting strong wires or pins into the bones and connecting them to rings. The rings are connected to each other by metal rods, and there is a nut attached to the middle of the rod that allows for adjustment of the length of the rod. By using this nut to gradually increase the distance between the rings by 1mm per day, new tissue is created in the bones, skin, nerves, and muscles, which grow together and become longer. Ilizarov surgery is a procedure that uses an Ilizarov apparatus to create new bones in cases where the bones are severely damaged or shortened due to a traffic accident or congenital deformity. Even a patient from Jeju Island who suffered from osteomyelitis after a fracture underwent Ilizarov surgery, which successfully joined the bone and extended the femur by about 7cm, resulting in a good treatment outcome. If the growth plate of a child who has not yet finished growing is damaged due to an accident, the cartilage cells in the growth plate can be destroyed, preventing the bone from growing properly and causing a discrepancy in the length of the arms or legs. 

  When the difference in leg length exceeds 2cm, the child may limp when walking, and their hips may become tilted, leading to scoliosis. If the surgery is not performed early, the scoliosis will be fixed, and later, corrective surgery for scoliosis will also need to be performed. When lengthening the bone, the treatment time is usually estimated as one month per 1cm. For example, if you want to lengthen 1cm of bone, you can increase it by 1mm per day, and it will take 10 days to increase 1cm. However, it will take an additional 20 days for the lengthened bone to fully harden like normal bone. Therefore, if you want to lengthen a 5cm bone, it will take 5 months. The time it takes for bones to harden varies depending on age, with shorter hardening times for younger people and longer times for older people or those with osteoporosis. Especially during the treatment period, if you smoke, the blood vessels supplying the new bone contract, and it takes 4-5 times longer to turn the lengthened bone into normal bone compared to non-smokers. Therefore, you should be very careful. This also applies to the treatment of fractures without lengthening the bone. Also, if you take pain relievers or anti-inflammatory drugs, these drugs can affect the substances that create new bones, so the treatment period may be longer. Therefore, during the treatment period, it is best to avoid taking pain relievers or take them as little as possible.  

  Recently, a lot of methods are being used to shorten the period of turning lengthened bones into normal bones. One such method is attaching an ultrasound device that can be carried around to the skin of the lengthened bone or fractured area and administering ultrasound for 20 minutes daily. In cases of osteoporosis, injections of growth hormone or injections of calcium or phosphate are also used to shorten the treatment period for lengthened bones. There are also pills containing calcium or phosphate, but to ensure good absorption in the stomach, there is an inconvenience of standing for 30 minutes after taking the pill. Nowadays, Ilizarov surgery is frequently performed on patients with familial or congenital dwarfism. However, in normal individuals with slightly shorter height due to familial factors, if the bone lengthening exceeds 20% of their original bone length, the muscles are heavily pulled, resulting in high pressure on the joints, which may lead to arthritis a few years after surgery. Another common complication is that the lengthened bone may break after the removal of the Ilizarov external fixator. If this happens, it is a very frightening complication that requires another surgery. Recently, in order to prevent such complications, a method of lengthening the bone while inserting a metal rod into the bone has been used. Although there is an advantage of no risk of bone fracture, a disadvantage is that a second surgery is required to remove the metal rod. For the most common congenital cause of dwarfism, achondroplasia, which is a skeletal dysplasia, muscles and skin tissues can stretch well compared to normal people, so it is possible to increase the length of the bone by more than 20%.
  The Department of Orthopedic Surgery at Gyeongsang National University Hospital has been treating many patients with dwarfism, including difficult cases of fractures, osteomyelitis, and limb deformities that are challenging to treat nationwide, since starting the Korean Little People's Association ( For about 12 years, the hospital has performed Ilizarov surgery on more than 2,000 patients. The hospital has also opened a website dedicated to Ilizarov surgery, where patients can receive consultations and answers to surgery-related questions ( The cost of Ilizarov surgery is between 2 to 10 million won for medical insurance-covered cases such as cerebral palsy and traffic accidents, and between 15 to 20 million won for cases not covered by medical insurance, such as low stature. The hospitalization period is usually about 2 weeks, and after discharge, patients need to visit the outpatient clinic every 1-2 weeks for X-ray imaging. If both legs require surgery, the hospitalization period may be delayed by about a month. 

Bowleg Correction and Bone Lengthening 10cm

Tibial Lengthening(8 cm) and Femoral Lengthening(8cm)

The Upper Limbs  Lengthening 10cm

The Upper Limbs Lengthening 10cm

Congenital Clubfoot Ilizarov Apparatus

Tibal Osteomyelitis
The Correction of Deformities and The Bone Lengthening

Brachydactyly Lengthening

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