Surgical correction of short stature in skeletal dysplasias

Limb lengthening has been undertaken in patients with short stature, including achondroplasia, hypochondroplasia and other skeletal dysplasias. The procedure consists of osteotomy of the tibia and fibula, and fixation of the limb using an external unilateral or circular fixator. Distraction (elongation) begins 1 week postoperatively, and during distraction osseous autoregeneration occurs. Consolidation of the autoregenerate takes about twice the time needed for lengthening, and the fixator is gradually mobilized during this time to allow greater weight-bearing. In 26 patients with short stature, the mean length gain was 10.1 cm (range, 7.3-14.8 cm). Transient deviation of the limb axis was observed in 80% of the patients, but reoperation was necessary only in 15%. Other complications included transient pain (70%), infection (45%), torn wires (40%), drop foot (35%), and stiffness of the ankle (30%) or the knee (15%). Not only must the possible length gain be judged, but it must also be ensured that no loss of function occurs.