Today I am going to talk about limb lengthening surgery and I am going to tell you what TikTok
and Baki have to do with one another.
Baki’s half brother Jack Hanma undergoes
limb lengthening surgery to reach a maximum height of 7’11” inches.
That’s a difference of 1 foot and 7 inches from his initial height of 6’4”.
Baki can get a little hyperbolic, so let’s see how this holds up in the realm of modern medicine.
Take a little trip over to TikTok – where I go to have my medical questions answered – and
you’ll find a surprising amount of information on the limb lengthening procedure. Recent medical
advancements have enabled us to increase someone’s height by up to 6 inches. That’s right, for around
$75,000.00, you can permanently change your height. Massive confidence boost… (Yao Ming Meme)
With studies that show that taller people are more likely to be liked,
occupy positions of power, and have more affluent careers,
it is not hard to understand why someone would want to undergo this procedure.
The procedure is fairly simple, minimally invasive and believe it or not there is
surprisingly little pain when the patient wakes up… In an interview with CTV News
Dr. Kevin Debiparshad goes on to say: “The surgery itself takes about an hour and a half to complete.
Patients are generally walking the same day, and using walking aid.” Debiparshad is a Canadian
orthopedic surgeon who works in Las Vegas, and is the chief executive of LimbplastX Institute,
a private clinic that specializes in cosmetic limb lengthening.
Let’s hear what TikTok has to say:
We’re talking four to six small incisions, a handful of implants and a take-home remote control
device that allows you to stretch your bones at the press of a button. Once the desired length
and height is achieved, the lengthening phase is stopped and the bone begins to regenerate.
As you may have guessed, the recovery phase is a little more onerous.
Dr. Debiparshad warns prospective patients, “It is the first few weeks
after that are considered the most difficult. There is tenderness and soreness,
and inflammation in the legs that can be uncomfortable. It also requires work
on the patient's behalf to go through the rehabilitation and the physical therapy,”
Patients recovering from limb-lengthening surgery can expect to have recurrent discomfort as they
progressively increase the length of the affected bone. Typically, this discomfort is localized to
the area of the bone that is metabolically active, at the fracture site. While not debilitating
in nature, it is enough to make things uncomfortable. Given the nature of the implants,
patients who undergo this procedure will be able to weightbear as tolerated while recovering
as the implants are load-bearing devices. However, they may also have to deal with the consequences
of recurrent pin tract infections, if the surgeon has elected to perform this technique
using an external frame rather than an internal implant. Patients can optimize their recovery by
keeping their pin sites clean, and by avoiding situations where the frame or pins can become
contaminated with dirt. They can also maintain strength and mobility by exercising regularly to
keep joints mobile and to prevent muscle atrophy. Weightbearing activity will help to maintain
bone density and will promote bone growth at the site of the osteotomy in the bone. Appropriate
exercises include squats, lunges, leg press, and step-ups. Suitable activities include walking,
cycling, elliptical, rowing, and stair-master. Patients will undergo frequent follow ups
and serial x-rays to confirm progression of healing of the osteotomy over time. Eventually,
after about 1 year, they can begin to partake in athletic activities like running and jumping.
Well, athletic activities do not sound like no-holds-barred hand to hand combat with some
of the most deadly fighters in the world. But then again, Jack Hanma is not your average man.
First of all, his resolve is superhuman. Jack Hanma will stop at nothing to avenge his mother,
Diane Neil, a Canadian United Nations operative who was raped by Yuujiro Hanma during the Vietnam
War. Yes he is both the son of “the strongest creature on earth,” and one of his greatest
enemies. His hatred for his father pushes him to take extreme risks in order to increase
his physical prowess. This is a man who underwent such rigorous physical training, he found himself
on the verge of death. Suicide by overtraining– if not for a mad scientist's steroid cocktails.
While the typical limb lengthening procedure is completed one bone at a time,
Jack underwent a compound procedure of all the long bones in his body at once.
Eight sites in total… Even in the Baki universe, this procedure was unprecedented and risky:
Oh and did I mention he underwent this procedure MULTIPLE. TIMES. You know, like more than once?
Not only at multiple sites, but multiple times in the same bones as well. It also seems that he
used a more extreme, and perhaps experimental procedure when compared to common practice.
Obviously, Keisuke Itagaki did his research because the procedure as presented in Baki,
isn’t inconceivable. There is even a device that exists similar to the one used on Jack Hanma.
This external fixation device, known as an Ilizarov frame,
is from Siberia Russia and can correct and alter bone as desired by turning the bolts,
And it must have worked because:
He must have worked his ass off in recovery. The aftermath of a surgical procedure with 8
fixation sites (all pushed beyond the comfortable recoverability of the bones involved) would be
incredibly uncomfortable, and a patient would be almost entirely immobilized for some time.
You can’t rely on a walker when your arms don’t work either. Everything must be rehabbed at once.
Jack could expect to feel weak and significantly debilitated since the integrity of all long bones
in the body would be compromised at the same time. However, as noted simple weightbearing
would be possible due to the stability of the surgical implants. However, with 8 bulky frames
being present at the same time, ambulation would be awkward and Jack might find himself frequently
banging the frames on furniture or door frames, or getting clothing caught on the exposed wires
and hardware of the frame. With 8 potential sites, each being comprised of several fixation points,
the potential for pin site infections and cellulitis would be extremely high. While
showers would be possible, Jack would commit to up to 1 year of not submerging himself in water.
No bathing, no hottubs, no swimming. Nada. Not to mention that sleeping comfortably with 8
concurrent frames being present would be next to impossible. Even with all 4 extremities on
pillows, he would only be able to sleep on his back regardless of his favoured sleep position.
Sleeping on his side would be just too difficult. Other potential problems or
complications might include insufficient bone growth, malalignment of the lengthened limb,
failure of the osteotomy to heal, flexion contractures of nearby muscles,
premature union of the osteotomy, and limb length discrepancies. Many of these issues are related to
the particular technique utilized in performing the lengthening procedure. Newer procedures that
utilize adjustable intramedullary nails eliminate some of the issues associated with external
prosthetic devices and substantially improve the whole process. But 8 external ilizarov frames are
much more impressive and suit the Baki storyline much better. [video of clunky robot walking here]
Rehabilitation would have included a crap ton of weightbearing resistance strength training
to promote bone growth in response to Wolff’s Law, which states that bone will adapt to the
mechanical stress that is placed upon it. So basically, if you want the bone to grow in a
linear fashion longitudinally, you expose it to forces parallel to its axis, in other words,
along the length of the bone. Lots of standing, walking, and pressing for the lower extremities,
and pressing or pushing for the upper extremities.
It is possible that the drugs that Jack takes to enhance his physical ability also have a positive
effect on his ability to regenerate bone. Some drugs or hormones exist that might have this
effect which include growth hormone, insulin-like growth factors, and bone morphogenic proteins.
Growth hormone promotes periosteal bone formation and osteoblast activity thereby promoting bone
growth in a manner that makes bones thicker and more robust. Insulin-like growth factor stimulates
bone metabolism with significantly increased bone turnover and improved bone formation resulting in
a net positive state of bone homeostasis or balance, where more bone is created than is
resorbed by the body. Bone morphogenic proteins are involved in the promotion of osteogenic
differentiation of stem cells into osteogenic cells to facilitate osseous regeneration. But
getting the osteotomy to heal and promoting the growth of the bones is only part of the problem.
The limiting factor for Jack might have more to do with the ability of the nerves
and blood vessels to keep pace with the mechanically lengthened bones. In adulthood,
many of our physical characteristics are fixed. We have a vasculature of a fixed length and bones of
a fixed size. When we mechanically change the length of a bone, our vasculature and nerves
will lengthen biologically to some degree in response to the change. But this biological
compensation may not be able to keep pace with more drastic mechanically induced changes. While
blood vessels might tolerate continuous tension while lengthening more readily,
nerves are less resilient, tolerating only 2-3% change in length relative to the length of the
limb. This would leave Jack able to gain only a few inches in height with each operation.
I wonder how Keisuke Itagaki explains this… Because while Jack’s first surgery helped him
gain just under 8 inches, his second surgery helped him gain another foot on top of that.
We went from somewhat within the realm of science to
way out in Baki space. But however he managed it, Jack’s results certainly eclipse those
of people who are getting this surgery on TikTok. [Photoshop of Jack Hanma on TikTok]
Whether you’re interested in entering combat with the world’s strongest creature,
or just looking to gain a couple extra inches to boost your confidence–
you have options. Expensive options… but options nonetheless. Welcome to 2022. Thanks for watching