The Journal of Bone and Joint Surgery, Vol 76, Issue 3 379-389, Copyright © 1994 by Journal of Bone and Joint Surgery, Inc
Acute lengthening of shortened lower extremities after malunion or non-union of a fracture
EE Johnson
Department of Orthopaedic Surgery, University of California at Los Angeles 90024.
Forty-nine skeletally mature patients who had either a non-union or a
malunion of a fracture of the tibia or the femur had correction of the
deformity and acute axial lengthening of the fractured bone. Distraction
was provided by the short AO/ASIF fracture distractor applied directly to
the site of the osteotomy or non-union. At an average of sixty-three months
(range, twenty-six to 105 months), the average increase in the tibial and
femoral length was 1.7 and 3.2 centimeters, respectively. There were no
compartment syndromes or ischemia secondary to any of the procedures. One
patient had a transient sensory-nerve loss. Fatigue fractures were seen in
two tibial plates, two femoral plates, and one femoral intramedullary nail
used for osteosynthesis. A non-union developed after four other femoral
intramedullary nailing procedures. One infection developed after
lengthening of a tibia. Restoration of normal length by acute lengthening
and internal fixation was achieved in twenty-seven patients. One patient
had overlengthening of one centimeter. Fifteen patients had residual
shortening of approximately one centimeter, three had shortening of more
than one to 2.5 centimeters, and three patients had more than 2.5
centimeters of shortening. The patients in this series had acute
restoration of limb length after traumatic shortening with a low prevalence
of complications of neurovascular compromise. Three of the thirty tibial
lengthenings and seven of the nineteen femoral lengthenings had to be
followed by at least one additional procedure to obtain union.
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