Leg lengthening by the Ilizarov technique for patients with sequelae of poliomyelitis

Limb length discrepancy is common in patients with sequelae of poliomyelitis. However, treatment of this problem is difficult and complicated. From 1988 to 1993, 71 patients with sequelae of poliomyelitis were treated with leg lengthening by modifications of the Ilizarov technique. Their median age at surgery was 26.4 years (range, 11.6-38.1 yr). Patients were divided into four groups according to the method of treatment, with femoral lengthening in 18 patients, combined femoral and tibial lengthening in 6, tibial lengthening in 35, and tibial lengthening along and intramedullary locking nail in 12. At follow-up of 2 to 6.7 years, the combined femoral/tibial group had the greatest gain in length. Treatment time in the Ilizarov device was shortest in the tibial lengthening with locking nail group. The lengthening index, which was defined as days in the Ilizarov device required for each centimeter of lengthening (days/cm), was lowest in the tibial lengthening with locking nail group, followed by the combined femoral/tibial lengthening group. Complications such as soft tissue contracture, callus fracture and residual deformities were most common in the combined femoral/tibial lengthening group and the femoral lengthening group. Complications were least common in the tibial lengthening with locking nail group. The satisfaction rate was highest in the tibial lengthening with locking nail group. We found that in leg lengthening for patients with sequelae of poliomyelitis, callus maturation was slow, and patients tended to develop contractures despite physiotherapy, bracing or joint fixation. Concomitant and secondary surgery were frequently required to treat associated problems or residual deformities. Lengthening along an intramedullary locking nail can significantly shorten the treatment time with relatively few complications.