Abstract
Purpose: Despite renewed interest in limb lengthening in western countries, the method is not widely used in Africa where congenital or acquired malformations produce a significant number of indications. We reviewed the first cases of limb lengthening procedures performed over the last five years.
Material and methods: The series included ten patients, five male five female, mean age 16.3 years (5–28). Indications for lengthening procedures were limb length discrepancy which was painful, bothersome, or disabling (n=8) or loss of bone substance (n=3). Indications were established after history taking, physical and radiographic examinations (telemetry of the lower limbs to determine leg length discrepancy or identify gap, or to identify associated anomalies). The classical technique was used: external fixator, osteotomy, progressive lengthening, 1 mm/d after a latency period.
Results: Initially mean length discrepancy was 7.8 cm (range 3 – 16). Mean duration of external fixation was 207.9 days (60–294). The de Bastiani consolidation index was 24 d/cm. Nine complications were recorded and there was one therapeutic failure requiring amputation.
Discussion: Limping due to congenital or acquired leg length discrepancy is common in our region. When seen late, the discrepancy is generally greater than in western countries (mean in our series greater than in the literature) and is often associated with multiple anomalies further complicating therapeutic management (prolonged use of external fixation). Filling bone gaps by lengthening techniques is a very attractive solution which could avoid numerous amputations in the African setting.
Conclusion: Limb lengthening procedures remains a difficult technique to implement in Africa. This challenging situation is even more stimulating due to the very great potential for patient benefit.
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