Fractures after femoral lengthening using the Ilizarov method

Eighteen children with leg length discrepancies underwent femoral lengthenings using the Ilizarov method. Eight had concomitant tibial lengthening. Nine femoral and no tibial fractures occurred. Eight fractures occurred after lengthenings > 5 cm. Three occurred while in the frame. These healed without complication after frame extension. Six fractures occurred after frame removal. Treatment with spica casting left four patients with minimal angulation and one patient shortened. Five of nine patients lengthened for congenital discrepancies fractured. Only two patients lengthened for posttraumatic discrepancies fractured. We now preferentially lengthen the tibia because of the lower fracture rate. For substantial lengthening, we recommend concomitant tibial and femoral lengthening.