Mary Lisanti underwent bone-lengthening surgery performed by Scott Hoffinger.
Mary, 10, of Alameda was born with fibular hemimelia, which caused her left leg to be 3 inches shorter than her right. Hoffinger, an expert in treating the congenital bone deficiency, started laying the groundwork for surgically lengthening the leg back in 2003. “Mary was only 6 months old when we started seeing Dr. Hoffinger,” said her father, Mike Lisanti. “He immediately put our family at ease and gave us trust that Mary could have a normal childhood. He said everything would be fine, and he was right.”
“The main thing we do for kids like Mary is prevent contracture or loss of range of motion in the ankle of the shorter leg,” Hoffinger explained. “We plan this through prosthetics and ankle-foot orthotics, thus allowing regular activities.”
True enough, said her dad. “There were no impositions,” he said. “Throughout childhood, Mary has been able to dance, play basketball and more.”
Hoffinger, who has successfully treated more than 50 leg-lengthening cases in his career, said that for kids like Mary, there is a point where prosthetics and orthotics cannot accommodate the entire difference. So, in early 2012, the lengthening surgery began taking shape. “Dr. Hoffinger cares about the whole patient,” Lisanti said. “He felt Mary’s surgery would work better when she was older and could understand what was going on. Additionally, a larger percentage of the leg can be lengthened then.”
After some initial nervousness, the good-natured fourth-grader was on board. “Well, I always wondered what it would be like if my legs were more even,” she said.
To make it happen, Hoffinger had to break Mary’s tibia and fibula to allow surgical attachment of a Taylor Spatial Frame (a type of Ilizarov apparatus named after its Russian inventor) to her leg. This external fixator, composed of pins, wires and metal rings, allows daily turning of struts that induce a gradual, millimeter-size lengthening. “You can grow bone across the room,” said Hoffinger, who monitored the ongoing lengthening for months in order to meet the approximate goal of 3 inches, which was achieved in October. After removing the fixator, Hoffinger put the leg in a cast, which came off in December. Mary can now take weight-bearing steps on the leg.
“She’s crutch-free,” said Lisanti, adding that he and his wife, Jennifer, are thrilled with the progress their daughter is making. “Mary’s riding her bike and starting some basketball shooting drills.”
Hoffinger noted that successful cases like this are always a collaborative effort. “Our team has exceptional experience with all types of orthopaedic problems, from trauma to fracture to sports injuries and more,” he said. “But it always helps when we are working with someone as determined and committed as Mary and her family.”
Looking back at his daughter’s journey, Lisanti saluted Hoffinger’s technical proficiency, and his family-centered approach to Mary’s care. “Dr. Hoffinger is always very caring and concerned, and he creates the best possible atmosphere for two-way communication,” he said. “From the beginning, he always made our entire family part of the treatment process, and we think this played a major role in Mary’s success.”
Robert Dicks is the senior media relations director for Lucile Packard Children’s Hospital.