This procedure corrects a leg length difference. With surgery and devices, a bone can be lengthened over a period of time. The process triggers bone growth and soft tissue lengthening.
Lengthening may be needed if you have a length difference due to: Trauma, such as a leg
fractureBone infectionTumorsCongenital defect or other condition that affects your bone growth, such as Klippel-Trenaunay syndrome
Short stature, such as dwarfismPolioCerebral palsy
If the difference is not corrected, it can cause excess strain on joints. You could have pain in your knee, hip, or ankle. You may develop
and back pain.
Correcting the problem can help improve walking and reduce your risk of other problems. Depending on the technique, several inches may be added.
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like: Excess bleedingAdverse reaction to anesthesiaInfection (may be around the pins or wires that are inserted during the procedure)Blood clotsNausea and vomitingJoint stiffnessBone length may not be exact (such as longer or shorter than planned)Muscle contraction (muscle shortens)Nerve injuryProblems with the new bone forming
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:
SmokingDrinkingChronic disease such as diabetes or obesity
Your doctor may do the following: A physical examMeasure your legs
Before the surgery: You may be asked to stop taking some medications up to one week before the procedure.
Avoid eating or drinking after midnight the night before surgery.
This procedure will be done in stages. The first stage is a procedure called an
osteotomy. The doctor will make an incision in the leg and cut the bone. The doctor will select a fixation device for the leg. This will stabilize the bone while it is being lengthened. Options include:
External fixation device—This framed device is positioned around the leg. Pins and wires are placed through the skin and tissue to reach the bone and lengthen it. Some have a dial attached to the frame. This dial is turned to slowly lengthen the bone.Internal fixation device—This is placed inside the leg. It is positioned on the bone. Some of these devices have a nail with a tool that automatically lengthens the bone. In other cases, it is used with the external device.
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Lengthening will be done at a rate of about 1 mm (millimeter) per day. This stage may start a few days or weeks after the osteotomy and last for a couple of months. Depending on your device, you will adjust it several times during the day. Your body will slowly regenerate new bone in the small space that was created between the bone ends.
During the next stage, your bone will heal. You will be able to put more weight on your limb. X-rays will be taken. When the healing process is completed, the fixation devices will be removed.
The osteotomy can take about 2 hours. This depends on the extent of the surgery.
The lengthening process can take 2-3 months.
Anesthesia prevents pain during surgery. Your doctor will give you pain medicine after surgery. You may have discomfort from the fixation devices.
The surgery is done in a hospital. The usual length of stay is 1-3 days.
At the hospital, the staff will: Give medication to prevent blood clotsHave you breathe deeply and cough regularly to prevent fluid build-up in the lungsEncourage you to get out of bed and walk using crutches or a walkerHave you start physical therapy the day after surgeryTeach you how to adjust the fixation devicesTeach you how to care for the pin and wire sites for an external fixation device
During your stay, the hospital staff will take steps to reduce your chance of infection such as: Washing their handsWearing gloves or masksKeeping your incisions covered
There are also steps you can take to reduce your chances of infection such as: Washing your hands often and reminding visitors and healthcare providers to do the sameReminding your healthcare providers to wear gloves or masksNot allowing others to touch your incisions
Leg lengthening will take place at home. For a smooth recovery: Use crutches or a walker. Do not put weight on your leg until your doctor gives you permission.If you have a device that needs to be adjusted, carefully adjust it throughout the day as instructed.Keep the external fixation device clean, especially around the pins and wires, to prevent infection.Work with a physical therapist. They will focus on stretching and strengthening your leg.Take pain medication as directed.
The entire process can take up to 6 months.
Contact your doctor if any of the following occurs: Signs of infection (such as fever, chills)Redness, swelling, increasing pain, excessive bleeding, or discharge around the incision or pin and wire sitesPain and/or swelling in the feet, calves, or legsPain that you cannot control with the medication you were givenCough, shortness of breath, chest painSevere nausea or vomitingNumbness, tingling, or loss of feeling in your leg, knee, or footProblems or concerns about the fixation devices
If you think you have an emergency, call for medical help right away.
Limb length discrepancy. American Academy of Orthopaedic Surgeons Ortho Info website. Available at:
http://orthoinfo.aaos.org/topic.cfm?topic=a00259. Updated July 2007. Accessed December 12, 2014.
Limb lengthening. International Deformity and Lengthening Institute website. Available at:
http://www.ilizarov.org/ll.pdf. Accessed December 12, 2014.
Limb lengthening. Scottish Rite Hospital for Children website. Available at:
http://www.tsrhc.org/limb-lengthening. Accessed December 12, 2014.
Paley D. Limb lengthening introduction. Limb Lengthening.us website. Available at:
http://www.limblengtheningdoc.org/limb_lengthening_intro.html. Accessed December 12, 2014.
Rozbruch R. Limb lengthening: An overview. Hospital for Special Surgery website. Available at:
http://www.hss.edu/conditions_limb-lengthening-overview.asp. Updated September 22, 2009. Accessed December 12, 2014.
Last reviewed December 2014 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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