[Tibial lengthening using Judet's method. Apropos of 108 cases in children]

One hundred and eight tibial lengthenings were performed in 106 children using the technique and apparatus of R. and J. Judet. The average lengthening obtained was 43,7 mm with a maximum of 60 mm. In some cases, repeated lengthening obtained 98 mm. Bone union was sound after an average of 4 months. It took 5 months in 13 cases, and a secondary graft was necessary in only 5 cases. Only one non-union occurred, due to infection. It seems that the results obtained with this technique were better than those obtained after internal fixation following removal of the distractor. In 5 instances vascular impairment was seen with recovery in 3 cases, but necrosis of a toe and of the tibialis posterior muscle in 2 cases. In 17 instances neurological impairment was seen with 2 showing persistent anaesthesia and one a paralysis of the extensor hallucis longus. However mild neurological impairment was more frequent than was initially expected. In some cases, preexisting knee deformities were aggravated by the leg lengthening. Some deformities at the site of the lengthening were related to an incorrect position of the distractor or to a contracture of soft tissues. It may also be made worse by non-union of the fibula. These deformities may react on the ankle or the foot and may continue to worsen after the completion of lengthening due to subsequent disturbance of growth in 15 p. 100 of cases.