Results of 21 Wagner limb lengthenings in 20 patients

Roentgenograms and charts were reviewed on 20 patients (average age: 13.2 years) who had 21 Wagner limb lengthenings since 1975. Lengthenings included 15 femora (six acquired, eight congenital, and one fibrous dysplasia), four tibiae, and two humeri (one acquired and one congenital). Average femoral lengthening was 6.6 cm; tibial, 5.9 cm; and humeral, 9.7 cm. Lengthening of femora with congenital shortening (6.5 cm) was nearly the same as femora with acquired shortening (6.8 cm), and 85% of all lengthenings were greater than 5 cm. Humeri were lengthened more than 50%. Seventy-two percent of patients were in the 50th percentile or less of stature; 61% were in the 15th percentile or less of stature. Seventy-five percent had complications, with 65% having more than one major complication: pin tract and superficial infections in 40%; deep infections in 20%. All infections were in femoral lengthenings. Nonunion occurred in two patients (10%), and fracture after plate removal in two patients (10%). Five patients (25%) had nerve palsies, and four of these resolved without treatment. Malunion rate was 20%. Five patients developed joint contractures. Complications did not correlate with amount of lengthening but congenital deformities had a higher incidence of complication. Eleven patients required 19 additional procedures necessitated by the lengthening procedure. Wagner leg lengthening is generally recommended when amputation is only other surgical alternative and a full, complete informed consent is given to the parents and patient.