To break it without surgery requires continuation of the lengthening at a faster rate than before. A painful pop may be experienced when the bone breaks. The patient is taught to reverse the turns by several millimeters when this happens, which automatically relieves the pain. If after 1 week of trying to separate the bone ends they do not pull apart, minor surgery is required to rebreak the bone. The patient is discharged home the same day.
Rehabilitation is very important during lengthening.
During combined femoral and tibial lengthening, the emphasis is on knee and ankle ranges of motion, respectively. Daily physical therapy is required. During bilateral double-level tibial lengthening, the feet are held in a 90 position by the Ilizarov device to prevent contracture. Emphasis during therapy is on walking and knee extension exercises. During bilateral humeral lengthening, the emphasis is on elbow range of motion.