BIFOCAL LIMB LENGTHENING - A PRELIMINARY-REPORT

Twenty-six bifocal lengthenings in 18 patients were reviewed in an att empt to identify the major indications, including extreme shortening, shortening with deformity and shortening with joint stiffness, soft ti ssue scarring, or obesity. A management classification is described an d almost all cases considered would fit into the ''high-risk linear'' or ''high-risk complex'' groups. Despite the complexity of the cases, the theoretical advantages of this technique such as reduced soft tiss ue tension, and increased fixator stability leading to faster and more reliable consolidation, appear to be borne out in practice. In nonpat hological states bone healing indexes of 21.5 days/cm for tibias and 2 2.4 days/cm for femurs were recorded. A major problem is knee stiffnes s during femoral lengthening resulting from the proximity of the dista l screws to the joint with transfixation of the fascia lata and vastus lateralis. Bifocal lengthening may well become a standard technique f or lengthenings >6 cm.