After many years of careful care and planning by Packard Children’s orthopedic surgeon Scott Hoffinger, MD, 10-year-old Mary Lisanti of Alameda, Calif., is now able to take weight-bearing steps on her left leg.
On December 18, Hoffinger removed a cast from Mary’s leg at his clinic in Berkeley. This seminal, happy moment was the culmination of many years of strategic treatment by the surgeon-researcher — an expert in treating fibular hemimelia — the birth deficiency that caused Mary’s left leg to be three inches shorter than her right.
Hoffinger started laying the groundwork for surgically lengthening Mary’s leg back in 2003. “Mary was only six months old when we started seeing Dr. Hoffinger,” said her dad, 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, according to dad. “There were no impositions,” Lisanti 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 4th grader was on board. “Well, I always wondered what it would be like if my legs were more even,” Mary 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 Mary’s leg. This circular device connects through a superstructure of pins and wires to allow a daily turning of struts that induce a gradual, millimeter-size lengthening. “You can grow bone across the room,” explained Hoffinger, who monitored the ongoing lengthening for months in order to meet the approximate goal of three inches, which was achieved in October. After removal of the frame, Mary received the cast and then an early Christmas gift when it was taken away in December.
“Now, she’s crutch-free,” said Lisanti, “and getting stronger and more mobile every day.” He and wife Jennifer are thrilled. “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 orthopedic 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 Mary’s journey, Lisanti saluted not just Hoffinger’s technical proficiency, but also 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,” Lisanti 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.”
