A New Apparatus for the Lengthening of Legs

Abstract

Rexford L. Diveley was born in Bazine, Kansas, in 1892, to the owner of a variety store. The family moved to the Oklahoma Territory (which had been opened for settlement in 1890). He returned to his home state, graduated from Hutchinson High School, and obtained his undergraduate and medical degrees (1917) from the University of Kansas. During WW I he served as head of a radiology unit in Limoges, France. After the armistice, he spent a year at Johns Hopkins in medicine, and then briefly went into private practice in St. Joseph’s, Missouri, north of Kansas City. He then established a radiology unit at Mercy Hospital in Kansas City. Shortly thereafter, he began working with Dr. Frank Dickson at the Christian Church Hospital, and changed his practice to orthopaedic surgery. In 1927 they established the Dickson-Diveley Clinic and by 1928 moved their practice to the St. Luke’s Hospital.

Dr. Diveley’s travels resulted in his becoming a member of the British and Italian Orthopaedic Societies and the Sir Robert Jones Dinner Club. He served as treasurer of the AOA, President of the Clinical Orthopaedic Society, and the Mid-Central States Orthopaedic Society. He was also a member of the Board of Governors of the American College of Surgeons.

Dr. Diveley coauthored a number of articles with Dr. Dickson and other colleagues at the Dickson-Diveley Clinic. We reprint here two brief articles. The apparatus he and Dickson described for limb lengthening used Kirschner wires, rather than larger pins, thus causing less soft-tissue damage [2]. Their technique was based on that described a few years earlier by Abbott [1] and presaged the device and technique described and popularized by Ilizarov [4]. The second article described a modification for Syme amputations which allowed a relatively cosmetic appearance for a Syme amputation [3]. Diveley and Kiene noted the bulbous and objectionable appearance of the traditional prosthesis, particularly for women (“A Syme amputation, which is the most conservative below-the-knee amputation and which provides the best functioning stump for weight-bearing, has been rarely recommended for women, because the unsightly prosthesis is objectionable.”). Their modifications include a lightweight, thin prosthesis made of laminated plastic reinforced with glass cloth and a posterior cutout to allow the large stump to slip through the prosthesis without enlarging the entire length.

Rexford L. Diveley, MD is shown. Photograph is reproduced with permission and ©American Academy of Orthopaedic Surgeons. Fifty Years of Progress, 1983.

References

1. Abbott LC. The operative lengthening of the tibia and fibula. J Bone Joint Surg Am. 1927;9:128–152.

2. Dickson FD, Diveley RL. A new apparatus for the lengthening of legs. J Bone Joint Surg Am. 1932;14:194–196.

3. Diveley RL, Kiene RH. An improved prosthesis for a Syme amputation. J Bone Joint Surg Am. 1956;38:219–221.

4. Ilizarov GA, Deviatov AA. Surgical lengthening of the shin with simultaneous correction of deformities [in Russian]. Ortop Travmatol Protez. 1969;30:32−37.

The following described apparatus may be useful to those who are interested in leg lengthening.

This apparatus, which we feel is an improvement over that first described by Abbott, replaces the pin traction by the Kirschner wire device. The apparatus is really a combination of the Abbott device and the Kirschner wire apparatus. It is a distinct improvement over the pin method of traction as the wire is much more easily and more accurately inserted and there is less damage done to the bone and soft parts at the points of insertion.

The apparatus consists of a frame, the proximal end of which is made up of a horse-shoe piece (B) which holds the two stationary Kirschner wires (C₁ and C₂). Upon the two side bars (D₁ and D₂) slides the second horse-shoe piece (E) which holds the second two Kirschner wires (F₁ and F₂) in place. Continuous traction is made on the distal fragments of the tibia by the nut G and the spring H, this traction being transmitted to the tibia through the horse-shoe piece E and wires F₁ and F₂. This traction can be varied by the tension of the nut and spring on the side bars. The variable foot piece (J) holds the foot in the desired position.

The operation is performed in the usual manner, an oblique or Z-shaped osteotomy being performed on the fibula. This is followed by a Z-shaped osteotomy of the tibia. The incisions are then closed by layers without drainage and a tenotomy on the Achilles tendon is performed if necessary. The Kirschner wires are then inserted, two in the upper fragment of the tibia and two in the lower fragment, just below and above the limitations of the Z-shaped osteotomy. It is very important that these be placed in the same vertical plane and the spacing of the wires can be made accurately by using the base piece of turnbuckle K. After the four wires are inserted, the traction apparatus is fitted into place, the four wires being inserted into the grooves of the two horse-shoe pieces. The wires are then made taut with turnbuckle K in the usual manner and the wires tightened in place with wrench L.

Fig. 1.

Showing details of apparatus.

Fig. 2.

Anterior posterior view of apparatus after leg has been lengthened.

Fig. 3.

Lateral view of apparatus after leg has been lengthened.