The effectiveness of post-lengthening plating after pediatric limb lengthening surgery: a comparative retrospective study

Objective: The primary objective of this retrospective comparative study was to compare clinical outcomes of post-lengthening plating, also called plating after lengthening (PAL), with external fixation alone in pediatric limb lengthening.

Methods: Plating after lengthening was applied to 41 limbs of 39 pediatric patients who underwent limb lengthening between 2020 and 2024. As a control group, 35 patients treated with only an external fixator during the same period were included. In both groups, the external fixator index, bone healing index, complication rates, and pain at final follow-up (assessed using a Visual Analog Scale [VAS] as a pain intensity instrument) were evaluated. For children aged <8 years, the VAS was completed by parents/guardians as proxy respondents. The success of 3-dimensional deformity correction was radiologically measured. As 2 patients in the PAL group contributed bilateral limbs, generalized estimating equations were used to account for clustering; complementary sensitivity and subgroup analyses were also performed.

Results: The external fixator index was 15.1 days/cm in the PAL group and 42.3 days/cm in the control group (P < .001). Patients achieved full weight-bearing an average of 98 days after PAL, while this period was 143 days in the control group (P < .001). The rate of major complications was 4.9% in the PAL group and 20% in the control group (P = .044); however, a sensitivity analysis excluding patients with prior infection from the control group showed that this difference did not retain statistical significance (P = .117). Pain at final follow-up was significantly lower in the PAL group (Pain VAS 1.3 vs. 3.6; P < .001; 63.9% relative reduction). The deformity correction rate was 92.4% in the PAL group and 85.6% in the control group (P = .004). Findings remained robust across all sensitivity and subgroup analyses.

Conclusion: Plating after lengthening appears to be a feasible option that may reduce external fixation time, accelerate bone healing, and lower residual pain at final follow-up in selected pediatric patients where intramedullary nailing is not applicable; however, longer follow-up and validated pediatric-specific patient-reported outcome measures are warranted to confirm long-term safety and outcomes.

Cite this article as: Engin M., Demirci A, Navruz A, Karabak B, Benkli Ş. The effectiveness of post-lengthening plating after pediatric limb lengthening surgery: A comparative retrospective study. Acta Orthop Traumatol Turc. 2026; 60(4), 0844 doi: 10.5152/j.aott.2026.26844.