{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T14:55:26Z","timestamp":1790434526860,"version":"4.1.0"},"reference-count":22,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2021,8,30]],"date-time":"2021-08-30T00:00:00Z","timestamp":1630281600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Previous studies on lengthening for achondroplasia have reported bilateral extensive femoral lengthening followed by bilateral extensive tibial lengthening. To decrease trauma on soft tissues and joints, we propose bilateral simultaneous moderate femoral lengthening and moderate tibial lengthening followed by a similar repeat lengthening a few years later. Fifty patients with achondroplasia underwent 65 simultaneous bilateral femoral and tibial lengthening procedures. Segment lengthening amount and adverse events were obtained from medical records. Mean follow-up after bone healing was 35.6 months. Mean tibial lengthening was 52 mm; mean femoral lengthening was 72 mm. Average healing index was 1.4 months\/cm for the tibia and 1 month\/cm for the femur. Mean duration of treatment with external fixation was 6.7 months (range, 4.4\u201310.5 months). Thirty-eight (76%) of 50 patients experienced one or more adverse events during lengthening. We observed 78 adverse events, 35 (45%) of which required additional surgical procedures. All resolved by the end of treatment. Mechanical axis deviation improved from a mean of 15 mm medially to 8 mm medially. Simultaneous lengthening of four segments in patients with achondroplasia is a feasible strategy. Compared with isolated femoral or tibial lengthening, distributing the lengthening between the femur and tibia decreases total external fixator time.<\/jats:p>","DOI":"10.3390\/children8090749","type":"journal-article","created":{"date-parts":[[2021,8,30]],"date-time":"2021-08-30T11:01:37Z","timestamp":1630321297000},"page":"749","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Simultaneous Bilateral Femoral and Tibial Lengthening in Achondroplasia"],"prefix":"10.3390","volume":"8","author":[{"given":"Lior","family":"Shabtai","sequence":"first","affiliation":[{"name":"Zucker School of Medicine at Hofstra\/Northwell, 500 Hofstra Blvd, Hempstead, NY 11549, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julio J.","family":"Jauregui","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Maryland Medical Center, 110 S. Paca Street, 6th Floor, Suite 300, Baltimore, MD 21201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John E.","family":"Herzenberg","sequence":"additional","affiliation":[{"name":"International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 W. Belvedere Ave, Baltimore, MD 21215, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin G.","family":"Gesheff","sequence":"additional","affiliation":[{"name":"International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 W. Belvedere Ave, Baltimore, MD 21215, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shawn C.","family":"Standard","sequence":"additional","affiliation":[{"name":"International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 W. Belvedere Ave, Baltimore, MD 21215, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip K.","family":"McClure","sequence":"additional","affiliation":[{"name":"International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 W. Belvedere Ave, Baltimore, MD 21215, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,8,30]]},"reference":[{"key":"ref_1","unstructured":"National Organization for Rare Disorders (2021, April 04). Achondroplasia. Available online: https:\/\/rarediseases.org\/rare-diseases\/achondroplasia\/."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1002\/ajmg.a.61974","article-title":"Clinical charts for surveillance of growth and body proportion development in achondroplasia and examples of their use","volume":"185","author":"Neumeyer","year":"2020","journal-title":"Am. J. Med. Genet. Part. A"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1007\/s11999-011-1983-y","article-title":"Is bilateral lower limb lengthening appropriate for achondroplasia? Midterm analysis of the complications and quality of life","volume":"470","author":"Kim","year":"2012","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1007\/BF00547160","article-title":"Limb lengthening in achondroplasia by Ilizarov\u2019s method","volume":"12","author":"Cattaneo","year":"1988","journal-title":"Int. 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Turc."},{"key":"ref_17","first-page":"280","article-title":"Limb lengthening in short-stature patients using monolateral and circular external fixators","volume":"15","author":"Lie","year":"2009","journal-title":"Hong Kong Med. J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"793","DOI":"10.2106\/00004623-199806000-00003","article-title":"Distraction osteogenesis of the lower extremity with use of monolateral exter-nal fixation. A study of two hundred and sixty-one femora and tibiae","volume":"80","author":"Noonan","year":"1998","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1612","DOI":"10.1302\/0301-620X.91B12.22418","article-title":"Femoral lengthening in achondroplasia: Magni-tude of lengthening in relation to patterns of callus, stiffness of adjacent joints and fracture","volume":"91","author":"Venkatesh","year":"2009","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Paley, D. (2021). Extensive Limb Lengthening for Achondroplasia and Hypochondroplasia. Children, 8.","DOI":"10.20944\/preprints202105.0268.v1"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1097\/01.bpo.0000226275.70706.d5","article-title":"Comparison of the complication rates between first and second (repeated) lengthen-ing in the same limb segment","volume":"26","author":"Griffith","year":"2006","journal-title":"J. Pediatric Orthop."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1097\/01241398-199211000-00010","article-title":"Bone remodeling after leg lengthening: Evaluation with plain radiographs, and computed tomography and magnetic resonance imaging scans","volume":"12","author":"Pech","year":"1992","journal-title":"J. Pediatric Orthop."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/8\/9\/749\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:55:13Z","timestamp":1760165713000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/8\/9\/749"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,30]]},"references-count":22,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,9]]}},"alternative-id":["children8090749"],"URL":"https:\/\/doi.org\/10.3390\/children8090749","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,30]]}}}