Twenty orthopedic surgeons in five states delivered the same awful news to Melissa Arnold: The best way to fix her young son Adam's short thigh bone was to cut off his leg and fit him with a prosthesis.
"It was never an option for me," said Arnold, a freelance writer from Red Oak, Iowa, who sought medical opinions from Minnesota to Colorado. "I was quite certain that something like a short leg had to be fixed with something other than an amputation. It's too short, so you cut it off?"
It took years of searching, but Arnold finally found another treatment. Rather than amputate Adam's limb, surgeons in Baltimore would gradually lengthen it - by using its own healing power.
In an era of high-tech medicine, when doctors can implant small defibrillators in patients' chests and transplant entire organs, the mechanics of limb-lengthening admittedly seem crude. The surgery involves drills, a chisel and a mallet - and doctors break the bone in the name of fixing it.
But the results, in some cases, are astounding: Patients can gain anywhere from a few inches to a foot or more in limb length.
"I can't imagine what my life would be like if I had to strap my leg on every morning," said Adam Arnold, now 15, whose 1998 lengthening surgery gained him about six inches.
Dr. Dror Paley, an orthopedist at Sinai Hospital in Baltimore who performed Adam's operation, has done more than 5,000 lengthenings since 1987 (the process usually includes reconstructing deformed knee and hip joints or correcting club feet).
He contends that the majority of children with the most common birth defects that cause unequal leg lengths are losing their limbs unnecessarily.
"While amputation is something that any orthopedic surgeon knows how to do, it is a bit of a cop-out procedure, because what it's saying is, `I don't offer reconstruction,' " said Paley, co-director of Sinai's International Center for Limb Lengthening, which performed more than 500 lengthenings last year.
"I don't think it's fair that it's the only option they're getting," he said, referring to amputation. "The problem right now is lack of training in these newer technologies, lack of availability [of surgeons], lack of knowledge about how good the results are."
Only a handful of centers in the United States specialize in limb lengthening.
