Femoral and tibial lengthening

Results and complications are reviewed in 18 femoral and seven tibial lengthenings performed using Wagner's technique. Lengthening achieved averaged 5.7 cm for the femoral and 5.6 cm for the tibial patients. Shortening was congenital in origin in 12 patients, and a soft tissue excision is recommended for these individuals. Two nonunions developed and two stress fractures occurred after plate removal. Pin tract infections occurred in 15 patients and deep infection in three. No serious long-term sequelae of infection have been seen at follow-up averaging 3 years 3 months. Additional complications included: patella dislocation, posterior tibial subluxation, and partial peroneal nerve palsy. No hypertension was observed. Five of 25 patients had no complications; additional operative procedures were performed in eight patients. Wagner's technique of limb lengthening is exacting and complications, although often remediable, may be expected frequently. However, the method remains a significant advance in the management of limb length inequality in the young patient.