Limb Lengthening


Dr. Gavril Ilizarov, in 1951, was the first person to describe limb lengthening surgery.  He developed this concept as a way to treat tibia fractures in WWII veterans that did not heal.   Dr. Ilizarov knew that compressing two bone ends will stimulate healing.  Therefore, he placed a circular external fixator around the leg, and instructed his patient to gradually compress the fracture ends.  However, the patient actually turned his fixator the wrong way and lengthened the bone rather than shortened it.  What Ilizarov discovered from this revolutionized our treatment of limb length differences – there was new bone in the gap between the two ends of bone.  This prompted an extensive amount of research and development.  While Dr. Ilizarov proceeded to perform thousands of successful limb lengthening surgeries, Russian politics precluded him from communicating his findings with the rest of the world.  Finally, in the 1980’s, Italian surgeons became adept at limb lengthening techniques and this soon translated to the rest of the world.  Limb lengthening then began in the United States in the late 1980’s.  While there was a large resistance in the general orthopedic community regarding limb lengthening surgeries, now with documented numerous successes, limb lengthening has proven both to be safe, powerful, and effective. 

Over the past 50 years, the art of limb lengthening has evolved.  While it is more mainstream, and typically well-tolerated, limb lengthening is very much a family affair - it takes a large commitment from everyone.  While your child is lengthening, your physician will typically want to see you on a weekly basis to ensure things are lengthening properly.  In addition, physical therapy is very important during the lengthening process to prevent stiffness once the limb becomes longer.  This results in time missed from school (if lengthening is performed during the school year), and it is a commitment from the family to help your child get to all the appointments that are needed.  While the process can be a long one, the end results are typically life-changing and worthwhile.  Our staff can assist you and your family with getting home-bound forms filled out for school if necessary, and we will try our best to make the process as easy as possible.


In general, limb lengthening surgeries are performed by surgically breaking the bone and then stretching the bone daily until the goal length is desired.  It is a very specialized surgical skill, and only surgeons who are trained in limb lengthening should be performing the operation.  If the bone is lengthened too fast, it may not heal, and it places the surrounding muscles, nerves, and joints at risk for permanent damage.  If the bone is lengthened too slow, then it may heal too quickly, and the bone may not be able to reach its actual length.

There are two basic types of devices that are utilized at this time to perform a limb lengthening surgery- either some type of external fixator or an internal lengthening nail.  Only after a thorough discussion with your COA surgeon will you understand more about limb lengthening and then which device is most appropriate to lengthen you or your child’s bone.

Further questions about limb lengthening?:  This is a complicated topic that is best discussed with your physician in person.  If your child is currently undergoing a limb lengthening with an external fixator, and you need a copy of our post-operative instructions, please click here.   


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