Long-Term Radiological and Clinical Outcomes of Lengthening with the Ilizarov External Fixator in Lower Extremity Shortening: A Retrospective Study

Objective: The Ilizarov external fixator (EF) is a widely used orthopedic device for limb lengthening, deformity correction, and fracture treatment. It operates on the principle of distraction osteogenesis, stimulating new bone formation through gradual mechanical traction. This method allows simultaneous correction of axial deviations and joint contractures while preserving bone vascularization. Despite its advantages, the technique is associated with prolonged treatment durations and potential complications such as pin-site infections, joint stiffness, and delayed union. In this study, we aimed to evaluate the clinical and radiological efficacy of the traditional Ilizarov EF in the treatment of lower extremity shortening. Material And Methods: This retrospective study was conducted in the Department of Orthopedics and Traumatology at Çukurova University Faculty of Medicine. A total of 51 bones from 48 patients diagnosed with lower extremity shortening and treated with Ilizarov EF were analyzed. The cohort included 21 males and 27 females, with a mean age of 13.13 years (range: 2–18 years). The extent of shortening was determined using orthoroentgenograms. The severity of shortening was classified according to Paley’s difficulty scale, while postoperative bone and functional outcomes were assessed using Paley’s and the Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring systems. Complications were categorized according to Paley’s classification. Postoperative quality of life was evaluated using the SF-36 questionnaire. Results: The study analyzed 20 femurs and 31 tibias. The mean lengthening achieved was 5.2 cm (range: 2–10 cm), with a mean follow-up period of 31 months (range: 12–120 months). The mean duration of fixator use was 34.65 weeks (range: 18–72 weeks). Corticotomy was performed at the metaphyseal region in 42 bones and the diaphysis in 9; however, the difference in union times was not statistically significant (p = 0.876). The mean external fixator index (EFI) was 54 days/cm (range: 24–120 days/cm). Complications were observed in 45 patients, with 105 classified as minor and 21 as major. According to Paley’s criteria, excellent and good outcomes were achieved in 75% of femoral cases, 82.7% of tibial functional assessments, and 94.3% of tibial bone evaluations. Conclusion: The Ilizarov EF is an effective and modern treatment approach that enables simultaneous correction of limb length discrepancies and deformities in patients of all age groups and etiologies. A multidisciplinary approach, including comprehensive patient education and effective complication management, may further enhance clinical and radiological outcomes.