title: 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.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  Patients with A/H tolerated larger amounts of lengthening with fewer complications than those with other diagnoses.
authors.affiliation: Department of Orthopaedics , New Jersey Medical School, Newark, NJ , USA.
authors.forename: Seung-Ju
authors.initials: SJ
authors.lastname: Kim
authors.forename: Wendy
authors.initials: W
authors.lastname: Pierce
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Sabharwal
mesh_terms: D000130:Achondroplasia / Q000601:surgery*; D001827:Body Height; D001842:Bone and Bones / Q000002:abnormalities* / Q000601:surgery; D004392:Dwarfism / Q000601:surgery*; D016267:External Fixators; D005269:Femur / Q000601:surgery*; D006801:Humans; D017880:Limb Deformities, Congenital / Q000601:surgery*; D008141:Lordosis / Q000601:surgery*; D035002:Lower Extremity; D019857:Osteogenesis, Distraction; D011379:Prognosis; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome; D014424:Turner Syndrome / Q000601:surgery*