Severe growth retardation following limb lengthening: a case report

The first limb lengthening was reported by Codivilla in 1905. Common complications reported with this procedure include pain tract infections, angulation deformities, joint contractures, and residual limb length discrepancies. Growth arrest or severe growth retardation in the lengthened bones has rarely been reported. We report a case of a skeletally immature patient with right sided hemihypertrophy who underwent lengthening of the left lower extremity by the method of DeBastiani using Orthofix external fixators. Postoperatively he developed severe growth retardation in the lengthened limb, as evidenced by the Mosely straight line graph, and recurrence of his limb length discrepancy. The reason for this growth retardation remains unknown; however, we hypothesize that premature closure at one or more of the physes occurred because of increased tension across the growth plates. The practice of over-lengthening a congenitally short limb prior to physeal closure should be questioned because resumption of growth after lengthening may be unpredictable.