Grow­ing pains

The Star Malaysia - Star2 - - Healthy Bones -

To kick-start re­growth, a length­en­ing de­vice is im­planted into a long bone and the bone gen­tly cracked in half, be­fore be­ing re­set a dis­tance apart to be­gin the length­en­ing process.

NAT­U­RAL height is widely ac­cepted to be un­change­able. Look a lit­tle deeper, how­ever, and one may un­earth the world of stature ad­just­ment that has been grow­ing and de­vel­op­ing for more than half a cen­tury.

Sur­geons who per­form stature or limb-length ad­just­ment pro­ce­dures are scat­tered sparsely through­out the world, many with cen­tres that of­fer long-term res­i­den­tial af­ter­care quar­ters for pa­tients to stay in dur­ing their re­cov­ery term.

While the cosmetic as­pect of the surgery has gained pop­u­lar­ity in the past decade, the use­ful­ness of bone length­en­ing and ref­or­ma­tion has not waned in the field of re­con­struc­tive limb treat­ment.

Peo­ple suf­fer­ing from length dis­crep­ancy be­tween limbs due to con­gen­i­tal birth de­fects, sco­l­io­sis or at­ro­phied mus­cles can also ben­e­fit from stature ad­just­ment surgery.

A per­son’s fi­nal stature and limb length are nat­u­rally un­al­ter­able af­ter a cer­tain pe­riod due to the fus­ing of their growth plates.

These growth plates are lo­cated at ei­ther end of each of their bones and con­tinue re­gen­er­at­ing and length­en­ing bone un­til late teenage­hood or early adult­hood, when these growth plates os­sify to halt bone growth.

How­ever, some arm-length­en­ing surg­eries have been per­formed on chil­dren with bone de­for­mi­ties whose growth plates were still ac­tive.

To kick-start re­growth, a length­en­ing de­vice is im­planted into a long bone and the bone gen­tly cracked in half, be­fore be­ing re­set a dis­tance apart to be­gin the length­en­ing process.

New growth of bone forms be­tween the two halves and the whole bone even­tu­ally con­sol­i­dates into a ho­mol­o­gous struc­ture.

This ba­sic prin­ci­ple is also used in stature ad­just­ment to treat com­pli­ca­tions re­sult­ing from leg length dis­crep­ancy where the pa­tient’s spine and joints are sub­ject to ab­nor­mal pres­sure from un­even gait.

For cosmetic pro­ce­dures, in­ter­ested pa­tients are of­ten re­quired to an­swer a screen­ing ques­tion­naire be­fore they are granted a con­sul­ta­tion with the sur­geon.

The screen­ing helps sur­geons en­sure po­ten­tial pa­tients are se­ri­ous about un­der­go­ing the pro­ce­dure and are aware of risks as­so­ci­ated with the pro­ce­dure and its per­ma­nence.

T p t con­tact with sur­geon and con­sul­ta­tion it­self could take months to com­plete, de­pend­ing heav­ily on whether the sur­geon deems an ap­pli­cant suit­able.

Me­chan­ics of limb length­en­ing

Limb length­en­ing orig­i­nated with a bone treat­ment de­vice by Rus­sian or­thopaedic sur­geon Gavriil Ilizarov.

The de­vice, called the Ilizarov ap­pa­ra­tus, was mon­u­men­tal in the treat­ment and heal­ing process of bro­ken bones and is still used to­day.

Ini­tially used to cor­rect con­gen­i­tal limb ab­nor­mal­i­ties and

c p y f po­liomyeli­tis, it was even­tu­ally dis­cov­ered that the heal­ing po­ten­tial of bro­ken bone across a tiny dis­tance of sep­a­ra­tion could be used for limb length­en­ing and, con­se­quently, stature length­en­ing.

To­day, the Ilizarov ap­pa­ra­tus is used for both med­i­cal and cosmetic limb-length­en­ing pro­ce­dures.

Dif­fer­ent sur­geons of­fer dif­fer­ent meth­ods of limb length­en­ing. The ever-pop­u­lar Ilizarov ap­pa­ra­tus is one and oth­ers are newer, fully in­ter­nal im­planted length­en­ing de­vices that come in the form of in­tramedullary nails such as Pre­cice, Fit­bone or Al­bizzia.

The rods of these de­vices are in­serted into the cav­ity of a long bone and the nails are an­chored to ei­ther end of the bone to slowly p o pa

To pre­serve in­tegrity in a pa­tient’s overall skele­tal struc­ture, only long bones are suit­able to be length­ened.

Bones most com­monly op­er­ated on for cosmetic pro­ce­dures are the fe­mur and tibia in the leg as well as the humerus in the arm, but med­i­cal pro­ce­dures are per­formed on a wider range of bones de­pend­ing on the af­fected area.

Pa­tients seek­ing limblength­en­ing surgery are ad­vised to con­duct ex­ten­sive re­search and gain ex­pert med­i­cal opin­ion to make the most in­formed de­ci­sion they can be­fore un­der­go­ing this ir­re­versible pro­ce­dure.

THE pace of bone reg­u­la­tion and me­tab­o­lism dif­fers among in­di­vid­u­als and slows down with age. Os­teo­poro­sis oc­curs when the cre­ation of new bones can­not keep up with the break­ing down of old bones.

Os­teo­poro­sis af­fects men and women of all races and is more com­monly seen in post­menopausal women. The dis­ease leads to an in­creased risk of bro­ken bones with var­i­ous risk fac­tors such as age, gen­der, fam­ily his­tory and di­etary fac­tors com­ing into play.

For the long­est time, cal­cium was thought to be the an­swer to bone health con­cerns. How­ever, a study pub­lished by The BMJ found that women sup­ple­mented with cal­cium to pre­vent os­teo­poro­sis are at higher risk of suf­fer­ing from ath­er­o­scle­ro­sis, heart at­tack and stroke.

How can some­thing good be bad for us in an­other way? What could be the miss­ing link in cal­cium sup­ple­men­ta­tion?

Vi­ta­min K is a group of fat-sol­u­ble vi­ta­mins. Vi­ta­min K1 is a blood-clot­ting fac­tor eas­ily found in green leafy veg­eta­bles while vi­ta­min K2 plays the cru­cial role of cal­cium reg­u­la­tion. Much like bi­o­log­i­cal glue, vi­ta­min K2 helps plug cal­cium into our bone ma­trix.

Stud­ies have shown that vi­ta­min K2 helps im­prove bone strength and den­sity. At the same time, it pre­vents heart dis­eases by ef­fec­tively de­posit­ing cal­cium into where it be­longs – the bones and teeth.

With­out vi­ta­min K2, cal­cium that we con­sume floats freely in the blood­stream and de­posits in the ar­ter­ies.

This makes the ar­ter­ies pro­gres­sively stiff and nar­row (cal­ci­fi­ca­tion), im­ped­ing healthy blood flow to and from the heart. Over time, poor blood flow leads to a bur­dened heart and the in­creased risk of heart dis­eases.

Cal­cium, vi­ta­min D and vi­ta­min K2 have a syn­er­gis­tic ef­fect, which can­not be achieved when one is miss­ing.

Di­etary cal­cium is linked to many ben­e­fits, es­pe­cially bone health. Vi­ta­min D3, a nat­u­ral form of vi­ta­min D, helps your body ab­sorb cal­cium but vi­ta­min K2 com­pletes the puzzle by di­rect­ing that cal­cium to your skele­ton.

With­out vi­ta­min K2, the cal­cium that vi­ta­min D3 so ef­fec­tively lets in might work against you, build­ing up in your coro­nary ar­ter­ies rather than your bones.

Thus, cal­cium taken to­gether with vi­ta­min D3 and K2 may help cir­cum­vent the risks of heart dis­eases.

Pa­tients re­ceiv­ing oral an­ti­co­ag­u­lant treat­ment should con­sult their med­i­cal doc­tor be­fore tak­ing vi­ta­min K2 sup­ple­ments.

This ar­ti­cle is brought to you by Medis­pec (M) Sdn Bhd.

For more in­for­ma­tion, call 1300 800 228 or e-mail en­quiry@medis­pec.com.my.

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