The etiology of short stature affects the clinical outcome of lower limb lengthening using external fixation: A systematic review of 18 trials involving 547 patients
Open accessAbstract
BACKGROUND AND PURPOSE: Distraction osteogenesis (DO) has been used to gain height in short statured individuals. However, there have been no studies comparing the clinical outcome of limb lengthening based on the etiology of the short stature. We assessed whether different underlying diagnoses are associated with varied clinical outcomes in these patients. METHODS: We performed a systematic review of the literature pertaining to lower limb lengthening using external fixation for short stature. Clinical outcomes including amount of lengthening, healing index (HI), and complications based on the underlying diagnosis for the short stature were documented. RESULTS: 18 clinical studies were included, with 547 patients who underwent 1,581 lower limb segment lengthening procedures. Mean follow-up was 4.3 years. The average age at lengthening was less for individuals with achondroplasia/hypochondroplasia (A/H) (14.5 years) than for those with Turner's syndrome (TS) (18.2 years) or with constitutional short stature (CSS) (21.7 years). Mean height gained was greater in patients with A/H (9.5 cm) than in those with TS (7.7 cm) or CSS (6.1 cm) group. The HI was better in A/H (30.8 days/cm) and CSS (32 days/cm) than in TS (45.1 days/cm). The reported complication rate per segment was lower for A/H (0.68) and TS (0.71) than for CSS (1.06). INTERPRETATION: Patients with A/H tolerated larger amounts of lengthening with fewer complications than those with other diagnoses.
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Limited studies have shown limb-lengthening procedures can result in substantial height increase in women with TS.
“Limited studies258,259 have shown that limb-lengthening procedures (distraction osteogenesis) can result in substantial height increase in women with TS.”
From Clinical practice guidelines for the care of girls and women with Turner syndrome. (2024) · cites this paper as [258]
Complication rates for limb-lengthening procedures are still unacceptably high.
“However, the complication rates for these procedures are still unacceptably high258”
From Clinical practice guidelines for the care of girls and women with Turner syndrome. (2024) · cites this paper as [258]
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Clinical practice guidelines for the care of girls and women with Turner syndrome.
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- Authors
- Kim, S.-J., Pierce, W., & Sabharwal, S.
- Affiliations
- Rutgers New Jersey Medical School (US)
- Corresponding author
- Kim, Seung-Ju
- Venue
- Acta Orthopaedica
- Published
- 2014-03-20
- Volume
- 85
- Issue
- 2
- Pages
- 181-186
- ISSN
- 1745-3674 (ISSN-L)
- 1745-3682
- PMC
- PMC3967262
- OpenAlex
- W2022345589
- Cited by
- 37
- References
- 43
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 6 · 2023: 2 · 2022: 4 · 2021: 3 · 2020: 4 · 2019: 1 · 2018: 1 · 2017: 4 · 2016: 3 · 2015: 3
- FWCI
- 2.52
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Acta Orthopaedica (publishedVersion)
- Acta Orthopaedica (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Bone fractures and treatments
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Craniofacial Disorders and Treatments
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Connective tissue disorders research
- Keywords
- short stature, lower limb lengthening, external fixation, distraction osteogenesis, achondroplasia, hypochondroplasia, Turner syndrome, constitutional short stature, healing index, lengthening complications, height gain
- MeSH terms
- Achondroplasia, Body Height, Bone and Bones, Dwarfism, Femur, Humans, Lordosis, Prognosis, Tibia, Turner Syndrome, External Fixators, Treatment Outcome, Limb Deformities, Congenital, Osteogenesis, Distraction, Lower Extremity
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