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Limb Lengthening with a Submuscular Locking Plate
Chang-Wug Oh, MD, PhD1; Joon-Woo Kim, MD, PhD1; Seung-Gil Baek, MD1; Hee-Soo Kyung, MD, PhD1; Hyun-Joo Lee, MD1
1 Department of Orthopaedic Surgery, Kyungpook National University Hospital, 50, 2-Ga, Samdok, Chung-gu, Daegu, 700-721, Republic of Korea. E-mail address for J.-W. Kim: orthopedics@naver.com
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Based on an original article: J Bone Joint Surg Br. 2009 Oct;91(10):1394-9.

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Essential Surgical Techniques, 2013 Dec 24;3(4):1-9. doi: 10.2106/JBJS.ST.M.00041
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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.



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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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