Mr Paul Nesbitt FRCS (Tr & Orth) · Manchester
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Limb Length & Deformity Correction · Manchester

Restoring length, realigning limbs.

Specialist surgery for limb length discrepancy and multiplanar deformity, using circular frames, hexapod systems and internal lengthening nails — for both congenital conditions and the consequences of trauma, infection or growth disturbance.

Make an enquiry → How treatment works
Manchester Royal Infirmary
QualificationsFRCS (Tr & Orth) · MBChB
GMC Number7074098
Circular Frame PracticeOne of the UK’s highest-volume
TechniquesIlizarov · Hexapod · Magnetic Nails
Indemnity£10m
Affiliated With Manchester Limb Reconstruction Unit
The Principle

How a limb is lengthened.

Limb lengthening relies on a biological process called distraction osteogenesis — the body’s own ability to form new bone as two cut ends are gradually separated.

A controlled cut is made in the bone — a corticotomy — and either a circular frame, hexapod fixator or an internal magnetic lengthening nail is used to gradually separate the two ends, typically by around a millimetre a day, in small increments. The gap fills with new bone as the limb lengthens, in the same way a fracture heals, but guided over weeks rather than days.

The same principle allows angular and rotational deformity to be corrected at the same time as length is restored. Hexapod frames, in particular, allow multiplanar corrections — adjusting length, angulation, rotation and translation simultaneously — using a computer program individualised to each patient’s deformity.

“The goal is rarely length alone. Most patients need a combination of lengthening and realignment, and the plan is built around the whole limb — not just the bone.”

Limb length discrepancy and deformity can be congenital — present from birth, as in conditions affecting the development of the femur or tibia — or acquired, most commonly following trauma, growth plate injury in childhood, or bone infection. Mr Nesbitt’s practice covers both, working closely with paediatric colleagues where a growing skeleton is involved.

Mr Paul Nesbitt, Consultant Trauma and Limb Reconstruction Surgeon
Mr Paul Nesbitt, Consultant Trauma & Limb Reconstruction Surgeon.
Indications

Who this treats.

Limb lengthening and deformity correction is considered for a range of congenital and acquired conditions affecting the length or alignment of the leg.

i.

Congenital Limb Length Discrepancy

Conditions affecting the development of the femur or tibia that result in one leg being shorter than the other from birth or early childhood.

Paediatric & Adult
ii.

Post-Traumatic Shortening

Limb shortening following severe fractures, bone loss, or previous surgery, where length needs to be restored to improve gait and function.

Reconstruction
iii.

Growth Arrest & Paediatric Deformity

Growth plate injury or infection in childhood that leads to a developing discrepancy in length or alignment requiring planned correction.

Paediatric
iv.

Multiplanar Deformity Correction

Combined angular, rotational and translational deformity of the femur or tibia, corrected using computer-assisted hexapod frames.

Hexapod
Treatment Pathway

From plan to new bone.

Every lengthening or deformity correction follows a planned sequence, with regular clinic review throughout the distraction and consolidation phases.

i.

Assessment & Planning

Clinical assessment, full-length imaging and, where relevant, growth prediction to plan the amount of correction required and the device to be used.

ii.

Surgery

The corticotomy is performed and either a circular frame, hexapod fixator or internal lengthening nail is applied under the same anaesthetic.

iii.

Distraction Phase

Gradual lengthening and/or deformity correction is carried out over weeks, with regular X-rays to monitor the rate and quality of new bone formation.

iv.

Consolidation

Once the target length and alignment are reached, the new bone is allowed to harden and strengthen before the frame or nail is removed.

v.

Removal & Rehabilitation

The frame or nail is removed once healing is confirmed, followed by physiotherapy to restore strength, joint range and gait.

The Practice

A full toolkit for length and alignment.

Treatment is tailored to the deformity, the patient’s age and their goals — drawing on every major lengthening and correction technique in current use.

Ilizarov, Hexapod & Magnetic Nails The full range of circular frame and internal lengthening technologies, selected to suit each case
Congenital & Acquired Treating both developmental limb length discrepancy and the consequences of trauma, infection or growth arrest
100+ Complex frame and reconstruction cases managed each year by the Manchester unit
Questions

Frequently asked questions.

Answers to the questions most commonly raised by patients and families considering limb lengthening or deformity correction.

How much can a limb safely be lengthened?
The safe amount of lengthening depends on the bone involved, the cause of the discrepancy, the condition of the surrounding soft tissues and joints, and the patient’s age. This is assessed individually during planning, and where a large discrepancy exists, treatment may be staged over more than one procedure.
How long does treatment take from start to finish?
Treatment time depends on the amount of lengthening or correction required. Distraction typically proceeds at around a millimetre a day, followed by a longer consolidation phase before the frame or nail is removed. Your surgeon will give you an individual estimate based on your planned correction.
Is limb lengthening painful?
Surgery is performed under anaesthetic, and pain is managed in the same way as for any frame surgery or osteotomy. The daily distraction itself is usually a small, gradual adjustment, though some aching or stretching discomfort — particularly in muscles and soft tissue — is common during active lengthening and is managed with regular pain relief and physiotherapy.
What’s the difference between a frame and a lengthening nail?
A circular or hexapod frame sits outside the limb and allows length and alignment to be adjusted externally — including complex multiplanar corrections. An internal lengthening nail sits inside the bone and is adjusted using an external remote control, without an external frame. The choice depends on the deformity, the bone involved, and whether deformity correction as well as lengthening is required.
How do I arrange private treatment?
Private limb lengthening and deformity correction is carried out at The Alexandra Hospital, Cheadle. You can book online through Circle Health Group or enquire with the practice secretary — both are in the contact section below. You may self-refer or be referred by your GP or consultant, and the practice is recognised by major UK insurers.
Can deformity be corrected at the same time as lengthening?
Yes — this is one of the main strengths of hexapod frame systems, which allow length, angulation, rotation and translation to be corrected simultaneously using a computer-generated programme tailored to the individual deformity.
What does recovery and rehabilitation involve?
Rehabilitation runs throughout treatment, with physiotherapy to maintain joint movement and muscle strength during the distraction phase, and to rebuild strength and gait once the frame or nail is removed. Most patients remain mobile throughout, with weight-bearing status guided by the treating team.
Get in Touch

Make an enquiry.

For private assessment of limb lengthening or deformity correction at The Alexandra Hospital, book online or enquire below.

Book or Enquire

Patients, GPs & Consultants

Private assessment for limb lengthening or deformity correction is available at The Alexandra Hospital, Cheadle. You may self-refer or be referred by your GP or consultant. Please include relevant imaging and a summary of the problem with your enquiry.

Book online with Circle Health →
Private & Self-Pay

Patients & Families

Private consultations are available at The Alexandra Hospital, Cheadle. Patients may self-refer or be referred by their GP or consultant, and the practice is recognised by major UK insurers.

More contact options →