Residual amputee limb segment lengthening: a systematic review

Aims: This study aimed to systematically review the indications, techniques, complications, and insights identified for lower extremity residual amputee limb segment lengthening. Methods: Searches in PubMed, Google Scholar, Ovid Medline, Ovid Embase, and the Journal of Limb Lengthening and Reconstruction were performed using terms including "amputee, " "residual limb, " and "stump " combined with "lengthening, " "distraction, " "histogenesis, " "osteogenesis, " and "Callotasis. " Included articles described lengthening amputated tibias or femurs (other segments excluded). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were utilized. Descriptive statistics were performed. Results: Twenty-two studies reported lengthening 32 femurs and 31 tibias (63 total segments). Fifteen articles described a single segment, five described two to four (15 total segments), and two described five or more (31 total segments). Lengthening was performed to improve prosthesis fit (21/22 studies, 54/63 segments) or to optimize osseointegration (1/22 studies, 9/63 segments) and utilized an external fixator (52/63) or a motorized intramedullary nail (11/63). Femurs were lengthened an average of 7.7 & PLUSMN; 2.5 cm (60% & PLUSMN; 23%) and tibias 5.8 & PLUSMN; 1.8 cm (97% & PLUSMN; 53%) from a starting length of 12.5 & PLUSMN; 4.6 cm for femurs and 6.7 & PLUSMN; 2.3 cm for tibias. The most common minor problem was pin site infection. The most common major problem was over-lengthening bone beyond the soft tissue envelope, requiring flap coverage, bone excision, or knee disarticulation. Conclusions: Amputee lengthening can achieve measurable gains to improve prosthesis use. Over-lengthening can be difficult to manage, if not catastrophic. Osseointegration may be a further rehabilitation solution for amputees struggling with prosthesis problems and willing to consider surgical options.