Limb lengthening for limb length discrepancy: Overview, complications, and new treatment algorithm

doi:10.5312/wjo.v17.i5.114902

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World Journal of Orthopedics

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2218-5836

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Orthop. May 18, 2026; 17(5): 114902
Published online May 18, 2026. doi: 10.5312/wjo.v17.i5.114902

Limb lengthening for limb length discrepancy: Overview, complications, and new treatment algorithm

Jana A Kotaich, Giovanni D Yanni, Elissa E El Toum, Ali Ismail, Mohammad Daher, Amer Sebaaly

Jana A Kotaich, Giovanni D Yanni, Elissa E El Toum, Ali Ismail, Faculty of Medical Sciences, Lebanese University, Hadath 00000, Lebanon

Jana A Kotaich, Giovanni D Yanni, Department of Orthopedic Surgery, MEDICA Research Investigation, Hadath 00000, Lebanon

Elissa E El Toum, Ali Ismail, Department of Neurology, Medica Research Investigation, Hadath 00000, Lebanon

Elissa E El Toum, Department of Neurology, Saint Georges University of Beirut, Beirut 165146, Lebanon

Mohammad Daher, Amer Sebaaly, Faculty of Medicine, Saint Joseph University, Beirut 166830, Lebanon

Mohammad Daher, Amer Sebaaly, Department of Orthopedic, Hotel Dieu de France, Beirut 166830, Lebanon

Author contributions: Kotaich JA was responsible for conceptualization, methodology, investigation, writing original draft, review and editing; Yanni GD, El Toum EE, and Ismail A were responsible for methodology, investigation, and writing original draft; Ismail A was responsible for preparation of hand-drawn figures; Daher M was responsible for resources and critical review of the manuscript; Sebaaly A was responsible for supervision, guidance on study design and interpretation, writing review and editing; all authors have read and approved the final manuscript.

AI contribution statement: ChatGPT and Grammarly were used only for grammar checking and language polishing after the manuscript had been originally written by the authors. The authors confirm that no section of the manuscript, including the abstract, introduction, materials and methods, results, discussion, or conclusion, was generated by AI. AI tools were not involved in the study design, data analysis, interpretation of results, or scientific conclusions. No AI-generated images were used; all figures were hand-drawn or prepared by the authors using Microsoft PowerPoint.

Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.

Corresponding author: Jana A Kotaich, MD, Faculty of Medical Sciences, Lebanese University, Inside Uni Lb, Baabda, Mount Lebanon Governorate, Hadath 00000, Lebanon. kotaichjana@gmail.com

Received: October 10, 2025
Revised: November 25, 2025
Accepted: January 26, 2026
Published online: May 18, 2026
Processing time: 229 Days and 20.9 Hours

Abstract

Limb lengthening stands as a transformative surgical procedure, offering newfound hope for individuals suffering from limb deformities or discrepancies. Several studies underscore the efficacy of both external and internal fixators in correcting limb length discrepancy (LLD). The choice between these modalities depends on multiple patient-specific factors, with each method presenting distinct advantages and limitations. While the success of limb lengthening in managing LLD is well established, both short-term and long-term physical as well as psychological implications necessitate a critical evaluation of indications. The appropriateness of pursuing limb lengthening should be guided by meticulously considering the prospective physical benefits and psychological ramifications. To address this need, we present a novel treatment algorithm designed to guide clinical decision-making in the management of LLD. This algorithm integrates current evidence, complication patterns, and patient-centered considerations to provide a structured approach to selecting appropriate interventions. A multidisciplinary, patient-focused strategy remains essential for optimizing outcomes and improving the overall quality of life for individuals undergoing limb lengthening.

Keywords: Limb lengthening; Limb length discrepancy; Osteogenesis; External fixators; Complications; Ilizarov

Core Tip: Limb lengthening has become an essential surgical option for patients with limb length discrepancy, yet its complexity and associated complications demand structured guidance. This mini-review synthesizes current evidence on external and internal fixation methods and highlights both physical and psychological outcomes. Importantly, we introduce a new treatment algorithm for limb length discrepancy that integrates patient-specific factors, complication profiles, and multidisciplinary perspectives. By providing a practical framework, this algorithm aims to support surgeons in optimizing decision-making and improving both functional outcomes and quality of life in patients undergoing limb lengthening.