Limb-lengthening with a submuscular locking plate provides a good alternative for patients, especially children, in whom lengthening over an intramedullary nail would be difficult.
Step 1: External Fixation for Lengthening with Submuscular Plating
The first operation is divided into two steps, submuscular plating and external fixation with corticotomy; due to the anatomical characteristics, the procedures differ in the tibia and femur.
Step 2: Lengthening
Start distraction at seven to ten days after surgery and continue until the target length is achieved.
Step 3: Locking of the Distal Segment and Removal of the External Fixator
When the target length has been achieved, place screws into the distal segment through plate holes and remove the fixator.
Step 4: Postoperative Care
Start with partial weight-bearing, obtain a radiograph every four to eight weeks, and allow full weight-bearing with crutches when osseous consolidation is observed.
We prospectively performed limb lengthening using an external fixator and a submuscular locking plate in ten patients16.
Pitfalls & Challenges