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Limb Lengthening, an Overview

Limb lengthening used to only be possible in cases with lower grade PFFD (Aitken
class A). In 2004 the ability to lengthen other cases has gotten better - however - the maximum lengthening should not exceed 8-l2cm in older children and 4-6cm in younger children 2. The presence of a stable hip, knee, and foot are also very important.

Leg lengthening can be a very painful, very long, process with multiple surgeries
and complications. At the Maryland Center for Limb Lengthening they reported a 70% complication rate with 50% of cases requiring additional surgery to treat complications. 2 Before lengthening can begin, it is important to first stabilize the hip joint. Without this, they are at increased risk for dislocation of the hip joint during lengthening.

In the 1960s and 1970s leg lengthening was thought to be a very bad idea.
Drs. Westin and Guderson wrote in the "leg lengthening has been attempted with little
real success". Dr Krajbich wrote "With newer methods it may be possible that
in the future some of these patients may benefit from leg-length equaling
procedures. At this stage, however, it would be very much an experimental
undertaking."  Drs. Westin and Gunderson wrote "Leg lengthening has
been attempted in nine cases with little success and frequent complications.
One of the criteria for for consideration of femoral lengthening is the presence
of of a stable hip and knee rarely found in PFFD." Keep in mind that all
these articles were written in the 60's or 70's. Perhaps those 'newer methods'
that Dr. Krajbich mentioned are available today in 1997.  

On the brighter side, information at
Alfred I. DuPont Institute
indicates that lengthening is possible if
the following criteria are met:

  • patient has greater than 60% of predicted femoral length
  • predicted length difference at maturity is less than 17 cm (6 1/2 inches)
  • stable hip
  • stable foot

The patient will require one or more femoral lengthening and/or contralateral
epiphysiodesis (slowing growth in other leg).2 However, they warn
that "parents should understand the magnitude of the operative procedures
for length equalization, the potential risk, including amputation at less
desirable level, and the lengthened extremity will still not be

When to have lengthening: Our orthopaedic surgeons doctors do not want to operate on children before their brain has developed and is ready for surgery (e.g. not until they are mentally ready). Lengthening after the age of fourteen is not effective when the difference is large.

Here are two sites which advertise lengthening services

The Maryland Center for Limb Lengthening
and Reconstruction
and Ladisten: Ukranian Orthopaedic Company

PFFD book: