Circumferential periosteal sleeve resection for limb length inequality complicated by growth plate tether

Correction of limb length inequality can be achieved by stimulation of growth of the short limb. Circumferential periosteal sleeve resection has been reported as a safe and reliable method of stimulating longitudinal bone growth. We report the complication of growth tethers to the distal tibial physes in two patients following circumferential periosteal sleeve resection to the distal femur, tibia and fibula. This was done under direct vision. This complication may have arisen due to damage to the perichondrial ring as a result of raising the periosteum too close to the distal tibial physes. A limited response may be seen in young patients following this procedure as a result of this complication. Circumferential periosteal sleeve resection for limb length inequality is a treatment option that is not without complication.