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Review
. 2020 Mar 5;21(1):3.
doi: 10.1186/s10195-019-0541-3.

Limb lengthening history, evolution, complications and current concepts

Gamal A Hosny  1
Affiliations
Review

Limb lengthening history, evolution, complications and current concepts

Gamal A Hosny. J Orthop Traumatol. .

Abstract

Limb lengthening continues to be a real challenge to both the patient and the orthopaedic surgeon. Although it is not a difficult operative problem, there is a long and exhausting postoperative commitment which can jeopardize early good results. I aim to review the history, evolution, biology, complications and current concepts of limb lengthening. Ilizarov's innovative procedure using distraction histeogenesis is the mainstay of all newly developing methods of treatment. The method of fixation is evolving rapidly from unilateral external fixator to ring fixator, computer assisted and finally lengthening intramedullary nails. The newly manufactured nails avoid many of the drawbacks of external fixation but they have their own complications. In general, the indications for limb lengthening are controversial. The indications have been extended from lower limb length inequality to upper extremity lengthening, including humeral, forearm and phalangeal lengthening. A wide range in frequency of complications is recorded in the English literature, which may reach up to 100% of cases treated. With developing experience, cosmetic lengthening has become possible using external or internal lengthening devices with an acceptable rate of problems.Level of evidence: V.

Keywords: Achondroplasia; Cosmetic lengthening; Indications; Limb lengthening; Upper extremity lengthening.

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Conflict of interest statement

The author declares no competing interests.

Figures

Fig. 1
Fig. 1
Tibial lengthening case showing that the regeneration develops along the axis of the applied traction
Fig. 2
Fig. 2
a Femoral lengthening case during the latency phase after corticotomy. b Distraction phase. c Consolidation phase
Fig. 3
Fig. 3
a A 3-year-old boy, fibular hemimelia, tibial shortening and angulation. b Clinical photo. c Picture at the end of lengthening and deformity correction. d Picture after fixator removal
Fig. 4
Fig. 4
Malalignment of the tibia during distraction and application of hinges to correct it
Fig. 5
Fig. 5
a 53-year-old female with achondroplasia with knee and ankle deformities. b Bifocal corticotomy and application of Ilizarov Frame on the left side. c Bifocal corticotomy and application of Ilizarov Frame on the right side. d After fixator removal
Fig. 6
Fig. 6
a A 12-year-old boy with 10-cm post-traumatic humeral shortening. b Clinical photo showing left humeral shortening. c Plain X-ray at the end of distraction. d Plain X-ray after fixator removal
See this image and copyright information in PMC

References

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