Article Review Lower Extremity Bone Lengthening

Lower Extremity Bone Lengthening


  • Muhammad Alfa Septiano Yunus Medical Faculty of Universitas Sebelas Maret
  • Ismail Mariyanto Orthopaedic and Traumatology Departement, Universitas Sebelas Maret, Prof. Dr. R. Soeharso Orthopaedic Hospital, Surakarta, Indonesia
  • Bagus Iman Brilianto Orthopaedic and Traumatology Departement, Universitas Sebelas Maret, Prof. Dr. R. Soeharso Orthopaedic Hospital, Surakarta, Indonesia



Lower Extremity, Lower Extremity bone lengthening, bone lengthening, garviil illizarov


Limb lengthening is a useful method of elongation the bones in the arms or legs. This method is carried out
gradually and continuously so that bones and soft tissues such as muscles, skin, and nerves can increase in length
slowly. Ilizarov's method is the origin of much of the contemporary knowledge of bone elongation. Professor
Gavril Ilizarov is the one who developed bone transport (BT) which is one of the applications of DO based on the
displacement of bone fragments without limb elongation to treat trauma, non-union, and large bone defects
(mechanical effects of segmental bone). Ilizarov's bone transport technique has consistently played an important
role in protecting soft tissues and promoting effective functional recovery and rehabilitation of limb length. This
article was written to review the history, and current concepts of limb lengthening, biology, and complications.


Download data is not yet available.


Hosny, G., 2020. Limb lengthening history, evolution, complications and current concepts. Journal of

Orthopaedics and Traumatology, 21(1).

Birch J. A Brief History of Limb Lengthening. Journal of Pediatric Orthopaedics. 2017;37(Supplement


Hasler C, Krieg A. Current concepts of leg lengthening. Journal of Children's Orthopaedics.


Hvid I, Horn J, Huhnstock S, Steen H. The biology of bone lengthening. Journal of Children's

Orthopaedics. 2016;10(6):487-492

Herzenberg J. Recent advances in limb lengthening and deformity correction. Bone Abstracts. 2015;.

Guerreschi F, Tsibidakis H. Cosmetic lengthening: What are the limits?. Journal of Children's

Orthopaedics. 2016;10(6):597-604.

Reinker K. CORR Insights®: Cosmetic Lower Limb Lengthening by Ilizarov Apparatus: What are

the Risks?. Clinical Orthopaedics & Related Research. 2014;472(11):3557-3558.

Marwan Y, Cohen D, Alotaibi M, Addar A, Bernstein M, Hamdy R. Cosmetic stature lengthening.

Bone & Joint Research. 2020;9(7):341-350.

Sailhan F. Bone lengthening (distraction osteogenesis): a literature review. Osteoporosis International.


Journeau P, Lascombes P, Barbier D, Popkov D. Residual bone growth after lengthening procedures.

Journal of Children's Orthopaedics. 2016;10(6):613-617.

Launay F, Pesenti S. Bone lengthening: Bridging joints, soft tissue releases, physiotherapy. Journal

of Children's Orthopaedics. 2016;10(6):517-519.

Knutson G. Anatomic and functional leg-length inequality: A review and recommendation for

clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects and

clinical significance. Chiropractic & Osteopathy. 2005;13(1).

Reitenbach E, Rödl R, Gosheger G, Vogt B, Schiedel F. Deformity correction and extremity

lengthening in the lower leg: comparison of clinical outcomes with two external surgical procedures.

SpringerPlus. 2016;5(1).

Barakat A, Sayani J, Guryel E, O'Dowd-Booth C. Lengthening Nails for Distraction Osteogenesis:

A Review of Current Practice and Presentation of Extended Indications. Strategies in Trauma and Limb

Reconstruction. 2020;15(1):54-61.

Miraj F, Nugroho A, Dalitan I, Setyarani M. The efficacy of ilizarov method for management of long

tibial bone and soft tissue defect. Annals of Medicine and Surgery. 2021;68:102645.

Paley D. The ilizarov technology revolution: History of the discovery, dissemination, and technology

transfer of the ilizarov method. Journal of Limb Lengthening & Reconstruction. 2018;4(2):115.

Idulhaq M, Santoso A, Mariyanto I, Utomo P. Distraction osteogenesis at the site of previously cystic

bone lesion of Femur: A case report. International Journal of Surgery Case Reports. 2021;84:106153.

Santoso A, Kumara HC, Hadinoto SA, Prakoso DP, Idulhaq M, Sumarwoto T, et al. Acute-shortening

and re-lengthening (ASRL) procedure with monorail fixator to treat femur/tibia nonunion: A

retrospective study. Annals of Medicine and Surgery. 2021;68:102621.

Wu Y, Yin Q, Rui Y, Sun Z, Gu S. Ilizarov technique: Bone transport versus bone shortening-

lengthening for tibial bone and soft-tissue defects. Journal of Orthopaedic Science. 2018;23(2):341–5.

Dahl MT, Morrison S. Segmental bone defects and the history of Bone Transport. Journal of

Orthopaedic Trauma. 2021;35(4).

Blázquez-Carmona P, Mora-Macías J, Sanz-Herrera JA, Morgaz J, Navarrete-Calvo R, Domínguez

J, et al. Mechanical influence of surrounding soft tissue on bone regeneration processes: A bone

lengthening study. Annals of Biomedical Engineering. 2020;49(2):642–52.

Santoso A, Kumara HC, Hadinoto SA, Prakoso DPA, Idulhaq M, Sumarwoto T, et al. Acute-

shortening and re-lengthening (ASRL) procedure with monorail fixator to treat femur/tibia nonunion: A

retrospective study. Ann Med Surg [Internet]. 2021;68(July):102621. Available from:

Kaldani F, Santoso A, Mariyanto I. Brachymetatarsia of 4 metatarsal treated with distraction

osteogenesis : A case report. J Indones Orthop Traumatol. 2020;3(3):3–6.

Schnack LL, Oexeman S, Rodriguez-Collazo ER. An update on the practical management of a

hexapod system in lower limb orthoplastic reconstruction for acute shortening and relengthening

procedures [Internet]. Eplasty. HMP Global; 2022 [cited 2022Aug10]. Available from:

Black S, Kwon M, Cherkashin A, Samchukov M, Birch J, Jo C. Lengthening in Congenital Femoral

Deficiency. The Journal of Bone and Joint Surgery-American Volume. 2015;97(17):1432-1440.

Popkov A, Dučić S, Lazović M, Lascombes P, Popkov D. Limb lengthening and deformity correction

in children with abnormal bone. Injury. 2019;50:S79-S86.

Manggala Y, Angthong C, Primadhi A, Kungwan S. The deformity correction and fixator-assisted

treatment using Ilizarov versus Taylor spatial frame in the foot and ankle. Orthopedic Reviews.


Mohedano A, Castillo A, de Pablos J, Barrios C. Relevant advances in bone lengthening research: a

bibliometric analysis of the 100 most-cited articles published from 2001 to 2017. Journal of Pediatric

Orthopaedics B. 2019;28(5):495-504.

Teulières M, Langlais T, de Gauzy J, Rölfing J, Accadbled F. Bone Lengthening with a Motorized

Intramedullary Nail in 34 Patients with Posttraumatic Limb Length Discrepancies. Journal of Clinical

Medicine. 2021;10(11):2393.

Bilen FE, Kocaoglu M, Eralp L, Balci HI. Fixator-assisted nailing and consecutive lengthening over

an intramedullary nail for the correction of tibial deformity. J Bone Jt Surg - Ser B. 2010;92(1):146–52.

Blázquez-Carmona P, Mora-Macías J, Sanz-Herrera J, Morgaz J, Navarrete-Calvo R, Domínguez J

et al. Mechanical Influence of Surrounding Soft Tissue on Bone Regeneration Processes: A Bone

Lengthening Study. Annals of Biomedical Engineering. 2020;49(2):642-652.

Blázquez-Carmona P, Mora-Macías J, Morgaz J, Fernández-Sarmiento J, Domínguez J, Reina-Romo

E. Mechanobiology of Bone Consolidation During Distraction Osteogenesis: Bone Lengthening Vs.

Bone Transport. Annals of Biomedical Engineering. 2020;49(4):1209-1221.

Lee D, Kim S, Lee J, Park H, Kim T, Kim H. A Comparison of the Device-Related Complications

of Intramedullary Lengthening Nails Using a New Classification System. BioMed Research

International. 2017;2017:1-9.

Simpson AHWR, Shalaby H, Keenan G. Femoral lengthening with the Intramedullary Skeletal

Kinetic Distractor. J Bone Jt Surg - Ser B. 2009;91(7):955–61.

Rozbruch S, Kazmers N, Fragomen A. Prevention of pin site infection in external fixation: a review

of the literature. Strategies in Trauma and Limb Reconstruction. 2016;11(2):75-85.

Walker J. Pin site infection in orthopaedic external fixation devices. British Journal of Nursing.


Bafor A, Kold S, Iobst C, Rahbek O, Frost M, Duncan M. Complications in Elective Removal of 271

Bone Lengthening Nails (FITBONE, PRECICE and STRYDE). Strategies in Trauma and Limb

Reconstruction. 2021;16(2):110-115.

Rölfing J, Kold S, Nygaard T, Mikuzis M, Brix M, Faergemann C et al. Pain, osteolysis, and

periosteal reaction are associated with the STRYDE limb lengthening nail: a nationwide cross-sectional

study. Acta Orthopaedica. 2021;92(4):479-484.

Additional Files