Tibial lengthening.

Tibial lengthening as a means of correcting certain discrepancies in lower limb length has become a well-accepted, though rarely indicated, procedure. Success depends upon knowledgable evaluation of all factors involved in the problem, upon adherence to the indications and prerequisites, and upon strict attention to all details of the operation. Nearly all cases of tibial lengthening are accompanied or followed by problems and/or complications. Problems such as delayed union, inadequate union and failure of union must be anticipated and appropriately coped with. Complications such as fracture through the lengthened area, compartment syndromes, infection, and foot and ankle deformities must be prevented if at all possible, and aggressively treated when they occur. Utilizing the appropriate indications and meticulous technique, one can expect to achieve lengthening of 4--5 cm in nearly all cases. Bone grafting and internal fixation will be required in a significant number of tibial lengthenings in order to achieve strong, solid union. The technique currently employed by the authors utilizes the Anderson percutaneous osteotomy, accompanied by the Wagner apparatus. In critically analyzing the results of 73 personal cases of tibial lengthening, the authors conclude that the procedure is justified in carefully selected patients.