Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Mar 17;19(2):139-150.
doi: 10.1177/18632521251327127. eCollection 2025 Apr.

External fixators and lengthening systems in pediatric upper limb

Nunzio Catena  1 , Chiara Arrigoni  1 , Marcos Carvalho  2 , Ida Matic  3 , Sebastian Farr  4
Affiliations
Review

External fixators and lengthening systems in pediatric upper limb

Nunzio Catena et al. J Child Orthop. .

Abstract

The use of external fixators is part of the cultural background of orthopedic surgeons in treating numerous clinical conditions. Over the years, fixator design and biomechanical knowledge have led to different solutions and techniques, and bone lengthening and its better understanding come together with the development of external fixators and the application of the biological principle of distraction osteogenesis. The authors conducted a literature review about using external fixators and lengthening systems in pediatric upper limbs. Despite the applications of external fixators in upper limbs remaining much more limited than those of the lower limbs, there are indications of traumatic, congenital, tumor, and infectious etiologies. However, despite the spread of new systems of plate and screws and intramedullary lengthening nails, the problems about when to use external fixation remain unsolved. Another debated point is about using monolateral or circular frames for humeral lengthening and the correction of forearm deformities in multiple hereditary exostoses disease (MHE) or radial longitudinal deficiency sequelae. Monoaxial fixators retain a prominent role for skeletal lengthening in all the districts examined, although their role could be outclassed by the motorized intramedullary nails, especially for humeral lengthening. Hexapod systems are likely to represent the future for the correction of multiplanar forearm deformities; however, multicenter studies on larger series will be necessary to better validate their applications and advantages.

Keywords: External fixator; pediatric deformities; upper limb.

PubMed Disclaimer

Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
(A) Humeral shortening in achondroplasia. (B) Lengthening with an axial external fixator. (C and D) Final lengthening.
Figure 2.
Figure 2.
(A) Ulnar shortening in MHE. (B–D) Correction with an axial external fixator and distraction osteogenesis. MHE: multiple hereditary exostoses.
Figure 3.
Figure 3.
(A) Ulnar shortening in radial longitudinal deficiency. (B) Correction and elongation with the external axial fixator. (C) Final results after 3 cm of lengthening.
Figure 4.
Figure 4.
(A) Ulnar shortening and deviation in radial longitudinal deficiency. (B and C) Correction of the wrist axis and elongation with hexapod frame. (D) Final correction.
Figure 5.
Figure 5.
(A) Missed Monteggia 2 months after trauma. (B and C) Open radial head reduction and ulnar flexion osteotomy with an axial external fixator.
See this image and copyright information in PMC

References

    1. Hernigou P. History of external fixation for treatment of fractures. Int Orthop 2017; 41(4): 845–853. - PubMed
    1. Hosny GA. Limb lengthening history, evolution, complications and current concepts. J Orthop Traumatol 2020; 21(1): 3. - PMC - PubMed
    1. Farr S, Mindler G, Ganger R, et al.. Bone lengthening in the Pediatric Upper Extremity. J Bone Joint Surg Am 2016; 98(17): 1490–1503. - PubMed
    1. Calder PR, Faimali M, Goodier WD. The role of external fixation in pediatric upper limb lengthening and deformity correction. Injury 2019; 50 Suppl 1: S18–S23. - PubMed
    1. Fassett F. An inquiry as to the practicability of equalizing unequal legs by operation. Am J Orthop Surg 1918; 16: 277.

LinkOut - more resources