Fractures after Wagner limb lengthening

A retrospective review of our experience with fractures after 27 Wagner limb lengthenings (23 patients) was undertaken. Ten fractures occurred after lengthening in eight patients (six spontaneous, four traumatic). Seven patients fractured despite a "staged" removal of the fixation plate. Seven of 10 fracture patients required open reduction/internal fixation (ORIF) to obtain union and/or satisfactory alignment. Our results indicate that patients with a congenital limb length inequality are prone to spontaneous fracture after Wagner limb lengthening. These results raise serious questions regarding the quality of bone healing after a Wagner-type lengthening for congenital limb length inequality.