Limb lengthening and reconstruction orthopaedic surgeries: When medical negligence may arise

Author

Sophie Stuart

Associate

Limb lengthening and reconstruction surgeries are advanced orthopaedic procedures used to treat various conditions such as congenital limb discrepancies, traumatic injuries, and deformities caused by infection or bone cancer. These surgeries can significantly improve a patient’s quality of life by restoring mobility, alleviating pain, and improving limb function.

However, the complex nature of these procedures means that, when something goes wrong, the consequences can be severe. If medical professionals fail to follow appropriate clinical guidelines or provide substandard care, patients may be entitled to bring a medical negligence claim.

What is limb lengthening and limb reconstruction?

Limb lengthening is a surgical process used to gradually increase the length of a bone, typically using an external fixator or an internal lengthening device. This may be necessary for patients with:

Congenital limb length discrepancies
Traumatic injuries
Amputations requiring limb equalisation

The process occurs over several months and is usually carried out in carefully planned stages.

Limb reconstruction on the other hand, refers to procedures designed to restore the structure and function of a limb following injury, disease, or deformity. Reconstruction techniques may include:

Bone grafting
Osteotomy (bone realignment)
Use of implants or prosthetics

Any procedure requires meticulous surgical technique, thorough planning and comprehensive postoperative care. Failure at any stage could give rise to complications and in some cases to claims for orthopaedic negligence.

When can medical negligence occur?

Healthcare professionals owe their patients a legal duty of care. They must provide treatment that meets the standard of a reasonably competent practitioner in their field. Negligence occurs when this duty is breached and the breach causes avoidable harm.

To be successful, a medical negligence claim must satisfy two legal tests:

Breach of Duty

It must be shown that the care provided fell below the standard expected of a reasonably competent professional in that specialism. A claim will usually fail if the healthcare provider can demonstrate that a responsible body of clinicians would have acted similarly.

Causation

It must then be proven that, on the balance of probabilities (i.e. more than a 50% chance), the injury or poor outcome would have been avoided had the proper standard of care been met.

Common examples of negligence in limb lengthening and reconstruction

Surgical errors

These procedures require extreme precision. Common errors include:

Incorrect placement of external or internal fixation devices, causing malalignment or deformity
Poor surgical technique resulting in abnormal bone growth or failure to achieve intended length
Damage to nerves, blood vessels, or surrounding tissue during surgery

Inadequate preoperative assessment and consent

A full preoperative assessment is crucial to identify any risks or contraindications. Failures may include:

Incomplete imaging or assessment of bone and soft tissue
Failure to identify underlying conditions affecting healing
Inadequate consent procedures, particularly in paediatric cases where risks are not clearly explained

Poor postoperative monitoring

Post-surgical care is just as important as the surgery itself. Failures here can include:

Not recognising signs of infection, non-union, or delayed healing
Lack of follow-up imaging or clinical reviews
Insufficient rehabilitation advice, impacting mobility and recovery

Improper use or management of medical devices

Limb lengthening devices must be managed correctly throughout treatment. Negligence may occur where:

Devices are improperly adjusted or maintained
There is a failure to act when a device is malfunctioning
Infection or bone damage occurs due to poor hygiene or delayed treatment