Tibial lengthening with LRS fixator in a pediatric patient with congenital anterolateral bowing: A case report

Congenital anterolateral bowing of the tibia is a rare orthopedic condition that can lead to significant limb length discrepancy (LLD) during growth. Gradual limb lengthening with external fixation remains a reliable method to achieve limb equalization. LRS fixator offers a minimally invasive and adjustable treatment option for pediatric patients considering the growth potential.

We present the case of a 9-year-old boy with a known case of right-sided anterolateral bowing of the tibia, who presented with a 3 cm limb length discrepancy. The patient underwent minimally invasive corticotomy and tibial lengthening using a Limb Reconstruction System (LRS) external fixator. The postoperative period was free of complications with intended lengthening achieved.

Preoperative planning, growth potential and radiological assessment, and precise corticotomy are essential in limb lengthening procedures in pediatric patients. In this case, Paley multiplier method predicted a final discrepancy of about 6 cm at maturity which led to a decision to lengthen 3 cm at this stage and the External Fixator Index (EFI) was 50 days/cm, corresponding to five months of non weight bearing External Fixator use. No complications such as neurovascular compromise, pin tract infection, or joint stiffness were observed post-implant removal or during ROM exercises for rehabilitation.

Tibial lengthening using LRS is an effective method for managing moderate LLD in pediatric patients if the growth potential is adequately kept in account. Early intervention, meticulous surgical technique, and close follow-up are key factors for a successful outcome.