A REVIEW OF 240 PATIENTS UNDERGOING DISTRACTION OSTEOGENESIS FOR CONGENITAL POSTTRAUMATIC OR POSTINFECTIVE LOWER-LIMB LENGTH DISCREPANCY

BACKGROUND: We reviewed 281 lower limb lengthening in 240 patients tre ated at three centers for congenital, post-traumatic, or postinfective limb length discrepancy (LLD) in the period 1984 to 1992. STUDY DESIG N: A retrospective review was done of hospital charts and radiographs of patients who had completed lengthening at least 12 months prior to the beginning of the study, The variables studied included patients' a ge at operation, the bone segment lengthened, whether a corticotomy or an osteotomy had been done, the amount of lengthening planned and ach ieved, the level(s) of corticotomy or osteotomy, the external fixator used, and the difficulties encountered. RESULTS: Limb length discrepan cy was reduced within 2 cm (1.6 percent or lower) of the normal contra lateral leg in 249 (89 percent) lengthening in 208 patients, The avera ge time spent with the fixator in situ was 186.4 days (range, 94 to 61 7 days), with an average healing index of 35.3 days per cm (range, 26 to 43 days per cm), Femoral osteotomies or corticotomies healed faster than tibial osteotomies or corticotomies, The healing index in post-t raumatic and postinfective LLD was significantly lower than in congeni tal conditions, The younger patients showed a significantly decreased time to bone healing and fewer complications. CONCLUSIONS: A significa ntly greater number of difficulties were found in patients whose lengt hening exceeded 18 percent of the original length of bone, Bifocal len gthenings healed significantly faster than single level ones, The thre e external fixators used were equally effective for lengthenings of le ss than 20 percent, The Ilizarov and the Monticelli-Spinelli circular fixators were associated with a significantly decreased number of comp lications when lengthening above 20 percent were performed.