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This case report details orthopaedic cosmetic surgery tourism, an emerging trend where individuals seek orthopaedic cosmetic procedures abroad. While this practice is increasingly common, it lacks regulation, potentially endangering patients. Factors driving this trend include rising healthcare costs and lengthy waitlists in public healthcare systems. Patients often pursue surgery abroad to save costs, or access specialised procedures not available domestically.However, complications can arise, necessitating costly management back home. Surgeons may face challenges due to unfamiliarity with overseas care, while patients encounter language barriers and variations in medical standards. This case report highlights a 28-year-old male who underwent bilateral limb lengthening surgery in Turkey, experiencing serious complications.While existing data on cosmetic tourism mainly focuses on plastic and bariatric surgeries, documentation specific to orthopaedic cases is limited. This report underscores the need for further research and regulation in this rapidly growing field, to ensure patient safety and optimal outcomes.

Introduction: While traditionally a treatment for congenital deformities, limb-lengthening surgery has recently been utilized as a cosmetic solution for patients with less-than-desirable heights. Despite a growing rise in popularity, stature-lengthening surgery carries a host of social stigmas and ethical concerns. With the emergence of natural language processing artificial intelligence (NLP AI) models such as ChatGPT, patients interested in stature-lengthening surgery may turn to these chatbots for medical information instead of primary care providers. This study seeks to evaluate the quality and readability of NLP AI model responses to common questions regarding stature-lengthening surgery to ensure proper patient education and direction toward a licensed orthopedic surgeon. Materials and Methods: Eleven questions regarding limb-lengthening surgery were posed to ChatGPT version 3.5. All named authors reviewed the AI responses independently and utilized the following scoring systems to assess readability and quality: DISCERN, ChatGPT Response Accuracy Scoring (CRAS) developed by Mika et al., Flesch–Kincaid Reading Ease (FRES), and Flesch–Kincaid Grade Level (FKGL). Cohen’s kappa was utilized to determine the inter-rater reliability between each reviewer’s assigned DISCERN and CRAS scores. Results: The average DISCERN score across all independent reviewers was 55.2 ± 5.63, with an inter-rater reliability of 0.293, indicating good scores with fair agreement, respectively. The average CRAS score across all senior reviewers was 1.60 ± 0.63 with inter-rater reliability being 0.014, indicating none to slight agreement. The average FRES score was 14.8 ± 2.24, and the average FKGL score was 18.9 ± 11.0, indicating a required reading level of a college graduate. Conclusions: The results of our study show that NLP AI models provide generally high-quality responses to patient questions regarding stature-lengthening surgery. However, notable flaws were identified, including a high required education level for proper comprehension as well as an inability to cite source material used for each response.

Introduction: While traditionally a treatment for congenital deformities, limb-lengthening surgery has recently been utilized as a cosmetic solution for patients with less-than-desirable heights. Despite a growing rise in popularity, stature-lengthening surgery carries a host of social stigmas and ethical concerns. With the emergence of natural language processing artificial intelligence (NLP AI) models such as ChatGPT, patients interested in stature-lengthening surgery may turn to these chatbots for medical information instead of primary care providers. This study seeks to evaluate the quality and readability of NLP AI model responses to common questions regarding stature-lengthening surgery to ensure proper patient education and direction toward a licensed orthopedic surgeon. Materials and Methods: Eleven questions regarding limb-lengthening surgery were posed to ChatGPT version 3.5. All named authors reviewed the AI responses independently and utilized the following scoring systems to assess readability and quality: DISCERN, ChatGPT Response Accuracy Scoring (CRAS) developed by Mika et al., Flesch–Kincaid Reading Ease (FRES), and Flesch–Kincaid Grade Level (FKGL). Cohen's kappa was utilized to determine the inter-rater reliability between each reviewer's assigned DISCERN and CRAS scores. Results: The average DISCERN score across all independent reviewers was 55.2 ± 5.63, with an inter-rater reliability of 0.293, indicating good scores with fair agreement, respectively. The average CRAS score across all senior reviewers was 1.60 ± 0.63 with inter-rater reliability being 0.014, indicating none to slight agreement. The average FRES score was 14.8 ± 2.24, and the average FKGL score was 18.9 ± 11.0, indicating a required reading level of a college graduate. Conclusions: The results of our study show that NLP AI models provide generally high-quality responses to patient questions regarding stature-lengthening surgery. However, notable flaws were identified, including a high required education level for proper comprehension as well as an inability to cite source material used for each response. [ABSTRACT FROM AUTHOR]

Introduction: Patients undergo stature-lengthening surgery (SLS) with the hope of improving their psychological health. The presumption is that increased height will improve body-image and self-esteem. The use of motorized internal lengthening nail and lengthening and then nailing techniques has eliminated or minimized time in external fixation increasing interest in the procedure. Material and Methods: Fifteen patients (32 bone segments) who underwent SLS were included in the study. All patients were bilateral, and one patient underwent four-segment treatments in two stages. Psychological assessment was performed with the body image quality of life inventory (BIQLI), the situational inventory of body-image dysphoria (SIBID), and the multidimensional body-self relations questionnaire before surgery and at latest follow-up. Orthopedic data included length obtained, bone healing index (BHI), adjacent joint range of motion, and Association for the Study and Application of Methods of Ilizarov (ASAMI). bone and functional scores. Results: The mean magnitude of lengthening was 64 ± 9.3 mm (48–77) (P < 0.001), resulting in an average increase from 161 cm to 167.4 cm. Mean BHI was 0.86 month/cm. ASAMI bone and functional results were all excellent after average follow-up of 37 months, with no loss of adjacent joint range of motion. BIQLI score significantly increased from 0.62 ± 1.26 (range −1.6–1.9) to 1.67 ± 0.85 (range −0.16–2.6) (P = 0.02). SIBID score significantly improved from 1.3 ± 0.81 (range 0.4–2.5) to 1.02 ± 0.68 (range 0.42–2.1) (P = 0.03). Discussion: Patients' significant increase in BIQLI score postoperatively, when compared to their scores preoperatively, demonstrate higher satisfaction in their body-image following SLS. Significant improvement in patients' SIBID score demonstrate a decrease in the impact of stature dysphoria in patients' everyday life following SLS. Conclusion: SLS is a safe and effective treatment to increase height. In patients, psychological health, including body-image and self-esteem, is improved.

Background: Stature lengthening in skeletal dysplasia is a contentious issue. Specific guidelines regarding the age and sequence of surgery, methods and extent of lengthening at each stage are not uniform around the world. Despite the need for multiple surgeries, with their attendant complications, parents demanding stature lengthening are not rare, due to the social bias and psychological effects experienced by these patients. This study describes the outcome and complications of extensive stature lengthening performed at our center. Materials and Methods: Eight achondroplasic and one hypochondroplasic patient underwent bilateral transverse lengthening for tibiae, humeri and femora. Tibia lengthening was carried out using a ring fixator and bifocal corticotomy, while a monolateral pediatric limb reconstruction system with unifocal corticotomy was used for the femur and humerus. Lengthening of each bone segment, height gain, healing index and complications were assessed. Subgroup analysis was carried out to assess the effect of age and bone segment on the healing index. Results: Nine patients aged five to 25 years (mean age 10.2 years) underwent limb lengthening procedures for 18 tibiae, 10 femora and 8 humeri. Four patients underwent bilateral lengthening of all three segments. The mean length gain for the tibia, femur and humerus was 15.4 cm (100.7%), 9.9 cm (52.8%) and 9.6 cm (77.9%), respectively. Healing index was 25.7, 25.6 and 20.6 days/cm, respectively, for the tibia, femur and humerus. An average of 33.3% height gain was attained. Lengthening of both tibia and femur added to projected height achieved as the 3rd percentile of standard height in three out of four patients. In all, 33 complications were encountered (0.9 complications per segment). Healing index was not affected by age or bone segment. Conclusion: Extensive limb lengthening (more than 50% over initial length) carries significant risk and should be undertaken only after due consideration. [ABSTRACT FROM AUTHOR]

Aims: To systematically review the outcomes and complications of cosmetic stature lengthening., Methods: PubMed and Embase were searched on 10 November 2019 by three reviewers independently, and all relevant studies in English published up to that date were considered based on predetermined inclusion/exclusion criteria. The search was done using "cosmetic lengthening" and "stature lengthening" as key terms. The Preferred Reporting Item for Systematic Reviews and Meta-Analyses statement was used to screen the articles., Results: A total of 11 studies including 795 patients were included. The techniques used in the majority of the patients were classic 3- or 4-ring Ilizarov fixator (267 patients; 33.6%) and lengthening over nail (LON) (253 patients; 31.8%), while implantable lengthening nail (ILN) was used in the smallest number of patients (63 patients; 7.9%). Mean end lengthening achieved was 6.7 cm (SD 0.6; 1.5 to 13.0), and the mean follow-up duration was 4.9 years (SD 2.1; 41 days to 7 years). Overall, the mean number of problems, obstacles, and complications per patient was 0.78 (SD 0.5), 0.94 (SD 1.0), and 0.15 (SD 0.2), respectively. The most common problem and obstacle was ankle equinus deformity, while the most common complications were deformation of the regenerate after end of treatment and subtalar joint stiffness/deformity., Conclusion: Cosmetic stature lengthening provides favourable height gain, patient satisfaction, and functional outcomes, with low rate of major complications. Clear indications, contraindications, and guidelines for cosmetic stature lengthening are needed.Cite this article: Bone Joint Res 2020;9(7):341-350., (© 2020 Author(s) et al.)