Complications of leg lengthening: 46 procedures in 28 patients

Abstract

The results and complications of 46 leg-lengthening procedures in 28 consecutive patients were analyzed retrospectively. There were 24 femoral and 22 tibial lengthenings, performed for short stature (5 patients) and limb-length discrepancy (23 patients). Three methods were used: diaphyseal osteotomy, metaphyseal corticotomy, and distraction physiolysis. In the second group a satisfactory result was obtained more often and a lower complication rate was observed. The overall complication rate was high: 45 substantial problems occurred. We conclude that leg lengthening is difficult, requiring good preoperative examination and planning, and should be carried out only in specialized centers.

Complications of bone lengthening

“…The overall percentage of complications in the literature is high, exceeding 100% [4,5,6,7,14,15,16,18,19,20,23]. Although the muscles and fasciae grow as the limb is extended, problems can arise when the muscle growth rate is slower than the lengthening of the bone.…”

“…Although the muscles and fasciae grow as the limb is extended, problems can arise when the muscle growth rate is slower than the lengthening of the bone. In most reports, disorders of the joints are the most common serious complication [7,22,24]. However for Paley [21] muscle problems predominated, while Guarniero et al [14] rank superficial and deep infections of the pins among the greatest problems.…”

“…However for Paley [21] muscle problems predominated, while Guarniero et al [14] rank superficial and deep infections of the pins among the greatest problems. High complication rates are found in patients with congenital short femurs [13] when compared to dysplastic patients of low stature, probably because the latter experience fewer difficulties in moving their joints; their muscles and vessels are longer than their bones [9,10] and the condition of their tissues prior to lengthening is generally better [7].…”

Speeded gradual lengthening and secondary angled blade plate stabilisation for proximal tibial shaft non-union with shortening

“…Now that bone graft must be supplemented, speeded gradual lengthening seems to be reasonable. Minimising the EF insertion period can reduce the discomfort caused by the procedure and decrease the complication rate of EF [6,13]. In this study, the EF was placed with a median of 25 days (21-32), and no infection occurred.…”

“…Thus, the patient may suffer more discomfort. Cancellous bone graft may speed the healing process, but the success rate may be compromised by insufficient stability of the EF [6,7,13]. Converting to internal fixation is suggested when necessary to reinforce local stability and increase the union rate [4,6].…”