Essential Surgical Techniques
Limb Lengthening with a Submuscular Locking Plate
Chang-Wug Oh, MD, PhD; Joon-Woo Kim, MD, PhD; Seung-Gil Baek, MD; Hee-Soo Kyung, MD, PhD; Hyun-Joo Lee, MD

Overview

Introduction 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.

Results We prospectively performed limb lengthening using an external fixator and a submuscular locking plate in ten patients16.

Indications

Contraindications

Pitfalls & Challenges

Introduction

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.

Although distraction osteogenesis with an external fixator is widely used to treat limb-length discrepancy1-4, prolonged external fixation can cause many complications, such as pin-track infection, joint instability and stiffness, and refracture after fixator removal4-8. Lengthening over an intramedullary nail9-11 shortens the duration of external fixation, better protects distracted bone during the consolidation phase, and reduces rates of complications as compared with the use of an external fixator alone. In addition, this method allows patients to regain movement more quickly and return to activities of daily life in less time12,13. However, it is …


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