Plate assisted lengthening enables planned early external fixator removal in selected paediatric forearm deformities

Distraction osteogenesis is widely used to correct paediatric forearm deformities, but prolonged external fixation increases the risk of complications and treatment burden. Plate-assisted lengthening (PAL) provides internal stability during consolidation and may permit planned early external fixator removal. We evaluated the feasibility and preliminary clinical and radiographic outcomes of PAL in paediatric forearm deformities. Ten consecutive patients (age 6-16 years) underwent forearm lengthening using lengthening-over-plate (n = 6) or lengthening-and-then-plating (n = 4) between 2021 and 2024. Outcomes included external fixation duration, external fixation index (EFI), bone healing index (BHI), radiographic union, complications, and range of motion. Mean length gain was 2.8 cm, and mean external fixation duration was 50.9 days (EFI, 18.4 days/cm). External fixators were removed a mean of 9.6 days after completion of distraction. Radiographic union was achieved in all cases, with a mean BHI of 65.2 days/cm. No intra-operative or major complications occurred; one transient clawing deformity resolved after external fixator removal. Joint motion was maintained overall, with descriptive improvements in selected parameters. PAL was technically feasible in this small series and permitted planned early external fixator removal. Larger comparative studies with longer follow-up are needed.