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Yale Limb Restoration and Lengthening Program

Program Overview

The Yale Limb Restoration and Lengthening Program (YLRLP) focuses on the restoration of limb function in patients with complex limb challenges. Our patients receive a high level of coordinated care to provide them with the best opportunity for successful orthoplastic limb reconstruction.

Our patients have limb differences that fall into general categories:

Congenital: differences in the development of the limb.

Traumatic: severe injuries to the limb may result in loss of bone or soft tissue. This also includes some fractures that have not healed (nonunions).

Infectious: an infection of the limb can result in poor development, bone or soft tissue loss, or joint stiffness. This also includes infected implants and infection fractures.

Neurologic: some brain and spinal cord conditions can result in joint stiffness (contracture), which can interfere with function.

Oncologic: treatment of a tumor, whether benign or cancerous, may require complicated reconstruction to maximize the function of a limb.

Cosmetic: height surgery for individuals that wish to be taller.

Our program's expertise spans the lifespan from infancy through late adulthood, and prenatal consultation is also available.

Academic Opportunities

There are significant research opportunities generated by the program, including both clinical outcomes and population-based research. Trainees are welcomed in these academic endeavors. Fellows with the Orthopaedic Trauma Fellowship also work closely with this program to gain specialized training.

How Limb Lengthening Surgery Works - Yale Medicine Explains

The process of bone healing is remarkable. When a bone breaks, there's a natural process where the body starts a cascade of chemicals around the local area that then ultimately lead to new bone being formed. The problem is if a bone heals in a crooked position, it will stay that way. And sometimes bones break and they heal, and they're not long enough. People can have a limb length difference, which is where one leg or one arm is not as long as the other side. If your pelvis is not even then the spine has to accommodate this difference, which can lead to back pain, can lead to hip pain. This is why people with limb length differences end up with problems away from their legs like spine arthritis differences in the way you walk. Limb lengthening surgery is a many months process, so the very first part of the surgery is actually where the patient goes to sleep. The bone is cut and the surgeon implants a device or places an external fixator and then wake the patient up. Bones are really good at healing. And so if we can harness that biological power of the bone to heal and we allow it to start to heal itself, we let that healing process set up and then the next phase, which is called lengthening, is where we actually do the manipulations to stretch that healing response. In many cases, an external device is still actually recommended, but most of the time in a grown adult, we use implants, which are telescopic devices that go on the inside of the bone and can be activated from outside the body in a less invasive manner. So this means that the gradual stretching of the bone, which is biologically predictable, can be done without being an inpatient. So throughout the day, very slow, gradual corrections to lengthen the limb. When we reach our length, we enter what's called consolidation at this phase, the body has achieved its length and it's made new bone, which we call regenerate. And the regenerate just has to get strong enough to support the loads of the body. We've lengthened the structure, we've leveled the pelvis and now we just need to be sure that when we remove the rod, which typically happens about 10 to 12 months after the initial surgery, that the structure will be able to support itself. At Yale, it's really great to be on the cutting edge and limb lengthening is a fantastic example of that. By using our three dimensional technology here at Yale, we can get perfect results. The technology has been exploding, becoming much easier for patients to use, much safer for patients to use, and more rewarding because the process becomes a little bit less cumbersome for people using newer technology, along with an expert team here, makes this intervention accessible to a much broader patient population.

Yale Limb Restoration and Limb Lengthening Directors

Affiliated Faculty and Staff