{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:19:13Z","timestamp":1787753953624,"version":"build-2784847793"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Case:<\/jats:title>\n                    <jats:p>A 10-year-old boy with a left femur osteosarcoma treated with a growing distal femoral prosthesis developed a 6.5 cm limb-length discrepancy with erosion of the remaining femur. He underwent revision of the replacement with femoral transport and lengthening using an extramedullary lengthening nail. After treatment, his bone stock increased by 14 cm and his discrepancy decreased to 3.6 cm. He ambulates without assistive device using a shoe insert.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Extramedullary lengthening can increase bone stock and improve leg lengths. Multiple procedures may be required, and deformities can occur if lengthening is attempted beyond the tip of the intramedullary stem.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.cc.26.00001","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T18:03:53Z","timestamp":1776362633000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Extramedullary Lengthening After a Distal Femoral Replacement to Improve Bone Stock and Restore Leg Length"],"prefix":"10.2106","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7762-2906","authenticated-orcid":false,"given":"Lee M.","family":"Zuckerman","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4]]},"reference":[{"issue":"12","key":"bib1-20260416","first-page":"1700","article-title":"Current strategies for limb salvage and reconstruction in pediatric lower extremity malignant bone tumors: focus on growth preservation and functional outcomes","volume":"12","author":"Liu","year":"2025","journal-title":"Children (Basel)."},{"issue":"2","key":"bib2-20260416","doi-asserted-by":"crossref","first-page":"e258","DOI":"10.1097\/BPB.0000000000000891","article-title":"Long-term follow-up of children treated with the repiphysis expandable prosthesis for lower extremity bone sarcoma","volume":"31","author":"Masrouha","year":"2022","journal-title":"J Pediatr Orthop B."},{"issue":"6","key":"bib3-20260416","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1097\/BPO.0000000000001831","article-title":"Retrograde extramedullary lengthening of the femur using the PRECICE nail: technique and results","volume":"41","author":"Iobst","year":"2021","journal-title":"J Pediatr Orthop."},{"issue":"10","key":"bib4-20260416","doi-asserted-by":"crossref","first-page":"e978","DOI":"10.1097\/BPO.0000000000001593","article-title":"Extramedullary motorized lengthening of the femur in young children","volume":"40","author":"Dahl","year":"2020","journal-title":"J Pediatr Orthop."},{"issue":"suppl 2","key":"bib5-20260416","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1007\/s11420-020-09770-8","article-title":"Hip-sparing equalization procedures for leg-length discrepancy after total hip arthroplasty: a retrospective case series","volume":"16","author":"Makhdom","year":"2020","journal-title":"HSS J."},{"issue":"12","key":"bib6-20260416","doi-asserted-by":"crossref","first-page":"3083","DOI":"10.1007\/s00264-021-05099-x","article-title":"Staged reconstruction of unilateral neglected hip dislocation through total hip arthroplasty and subsequent intramedullary femoral lengthening","volume":"45","author":"Vogt","year":"2021","journal-title":"Int Orthop."},{"issue":"6","key":"bib7-20260416","doi-asserted-by":"crossref","first-page":"330","DOI":"10.3928\/01477447-20181102-02","article-title":"Use of magnetic growing intramedullary nails in compression during intercalary allograft reconstruction","volume":"41","author":"Vercio","year":"2018","journal-title":"Orthopedics."},{"issue":"11","key":"bib8-20260416","first-page":"1772","article-title":"Lengthening patients previously treated for massive lower limb reconstruction for bone tumors with the PRECICE 2 nail","volume":"10","author":"Campanacci","year":"2023","journal-title":"Children (Basel)."},{"issue":"2","key":"bib9-20260416","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2106\/JBJS.CC.22.00069","article-title":"All-internal limb lengthening with simultaneous corrective osteotomy after internal hemipelvectomy: a case report","volume":"12","author":"Femino","year":"2022","journal-title":"JBJS Case Connect"},{"issue":"1","key":"bib10-20260416","doi-asserted-by":"crossref","first-page":"27","DOI":"10.3928\/01477447-20221024-03","article-title":"Femoral discrepancy after childhood bone sarcoma surgery can be treated with magnetic intramedullary nails","volume":"46","author":"Alpan","year":"2023","journal-title":"Orthopedics."},{"key":"bib11-20260416","first-page":"369","article-title":"Reconstruction of bony defects with motorized intramedullary nails after tumor resection","volume":"73","author":"Zuckerman","year":"2024","journal-title":"Instr Course Lect."},{"issue":"3","key":"bib12-20260416","doi-asserted-by":"crossref","first-page":"e20.00183","DOI":"10.2106\/JBJS.CC.20.00183","article-title":"Salvage of distal femoral replacement loosening with massive osteolysis using impaction grafting: a report of 2 cases","volume":"10","author":"Carender","year":"2020","journal-title":"JBJS Case Connect."},{"issue":"7","key":"bib13-20260416","doi-asserted-by":"crossref","first-page":"1427","DOI":"10.1007\/s00264-020-04629-3","article-title":"The effects of length of femoral stem on aseptic loosening following cemented distal femoral endoprosthetic replacement in tumour surgery","volume":"44","author":"Zhang","year":"2020","journal-title":"Int Orthop."},{"issue":"9","key":"bib14-20260416","doi-asserted-by":"crossref","first-page":"3174","DOI":"10.1016\/j.arth.2021.04.035","article-title":"Metaphyseal stem tip location is a risk factor for aseptic loosening of cemented distal femoral replacements","volume":"36","author":"Greig","year":"2021","journal-title":"J Arthroplasty."},{"issue":"1","key":"bib15-20260416","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1186\/s12957-023-03047-0","article-title":"Aseptic loosening of tumor prostheses in distal femur after revision surgery: a retrospective study","volume":"21","author":"Li","year":"2023","journal-title":"World J Surg Oncol."},{"issue":"2","key":"bib16-20260416","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1002\/jso.25501","article-title":"Stanmore noninvasive extendible endoprosthesis in the treatment of bone sarcoma in the preadolescent","volume":"120","author":"Sambri","year":"2019","journal-title":"J Surg Oncol."},{"issue":"8","key":"bib17-20260416","doi-asserted-by":"crossref","first-page":"3585","DOI":"10.1007\/s00590-023-03590-2","article-title":"Osseointegration reduces aseptic loosening of primary distal femoral implants in pediatric and adolescent osteosarcoma patients: a retrospective clinical and radiographic study","volume":"33","author":"Welsh","year":"2023","journal-title":"Eur J Orthop Surg Traumatol."},{"issue":"6","key":"bib18-20260416","doi-asserted-by":"crossref","first-page":"2079","DOI":"10.1007\/s11999-015-4282-1","article-title":"Total femur replacement after tumor resection: limb salvage usually achieved but complications and failures are common","volume":"473","author":"Sevelda","year":"2015","journal-title":"Clin Orthop Relat Res."},{"issue":"1","key":"bib19-20260416","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1007\/s00402-025-05887-9","article-title":"Total femur replacement, indications for the procedure and its complications: a systematic review","volume":"145","author":"Wilk","year":"2025","journal-title":"Arch Orthop Trauma Surg."},{"issue":"3","key":"bib20-20260416","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1302\/0301-620X.100B3.BJJ-2017-0651.R1","article-title":"The use of a non-invasive extendable prosthesis at the time of revision arthroplasty","volume":"100-B","author":"Gilg","year":"2018","journal-title":"Bone Joint J."},{"issue":"5","key":"bib21-20260416","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1302\/0301-620X.101B5.BJJ-2018-1106.R1","article-title":"Mechanisms of failure and survival of total femoral endoprosthetic replacements","volume":"101-B","author":"Medellin","year":"2019","journal-title":"Bone Joint J."}],"container-title":["JBJS Case Connector"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.CC.26.00001","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:21:30Z","timestamp":1787750490000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.CC.26.00001"}},"subtitle":["A Case Report"],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":21,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.cc.26.00001","relation":{},"ISSN":["2160-3251"],"issn-type":[{"value":"2160-3251","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]}}}