{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T22:09:32Z","timestamp":1772489372038,"version":"3.50.1"},"reference-count":16,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,2,8]],"date-time":"2025-02-08T00:00:00Z","timestamp":1738972800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Limb lengthening is a surgical procedure intended to correct discrepancies and deformities in limb length or to enhance limb length for functional or cosmetic reasons. Short stature, often seen as a physical condition, can significantly affect a patient\u2019s quality of life. The advancement of limb lengthening methods, including the creation of hexapod external fixation systems, has heightened the precision and efficacy of these procedures. The Taylor spatial frame (TSF), a form of hexapod external fixator, grants three-dimensional control of bone movement and is increasingly used to rectify deformities and lengthen limbs. This systematic review aims to assess the effectiveness of the hexapod external fixator in limb lengthening and deformity correction compared to other external fixation systems, focusing on outcomes such as achieved lengthening, healing index, complications, and follow-up duration. Methods: A structured search was engineered in four crucial search engines (PubMed, Scopus, Web of Science, and Medline) spanning 2004 to 2024. Results: The studies included in this review indicate that the average lengthening accomplished with the hexapod fixator ranged from 3 to 5.9 cm, with a healing index between 37 and 68.6 days\/cm. The most frequent complications were pin site infections, compartment syndrome, and delayed union. The follow-up duration ranged from 6.8 months to 6 years. These studies also compared the hexapod external fixator with other external fixators, showing that while the TSF allowed more accurate deformity corrections, it often displayed a higher healing index. Conclusions: The hexapod external fixator, specifically the TSF, is an effective instrument for limb lengthening and deformity correction in patients with short stature. Although it provides superior three-dimensional control for deformity correction, the healing index and treatment duration can be longer compared to traditional external fixators. Further studies with larger sample sizes and extended follow-up are needed to perfect treatment protocols and thoroughly evaluate the long-term outcomes and complications associated with this technique.<\/jats:p>","DOI":"10.3390\/jcm14041091","type":"journal-article","created":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T03:39:47Z","timestamp":1739158787000},"page":"1091","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Use of Hexapod External Fixation in Limb Lengthening in Patients with Disproportionate Short Stature: A Systematic Review of the Last 20 Years"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5246-9714","authenticated-orcid":false,"given":"Gianluca","family":"Testa","sequence":"first","affiliation":[{"name":"Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1593-5294","authenticated-orcid":false,"given":"Michela","family":"Marchetti","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8311-9132","authenticated-orcid":false,"given":"Marco","family":"Sapienza","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martina","family":"Ilardo","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastiano","family":"Mangano","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Condorelli","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5664-8066","authenticated-orcid":false,"given":"Vito","family":"Pavone","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1007\/s11832-016-0791-z","article-title":"Cosmetic Lengthening: What Are the Limits?","volume":"10","author":"Guerreschi","year":"2016","journal-title":"J. Child. Orthop."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1007\/s11832-011-0361-3","article-title":"Clinical Value of the Taylor Spatial Frame: A Comparison with the Ilizarov and Orthofix Fixators","volume":"5","author":"Dammerer","year":"2011","journal-title":"J. Child. Orthop."},{"key":"ref_3","first-page":"e3","article-title":"Advances in Pediatric Limb Lengthening: Part 1","volume":"3","author":"Iobst","year":"2015","journal-title":"JBJS Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1016\/j.otsr.2017.03.006","article-title":"Correction of Axial Deformity during Lengthening in Fibular Hypoplasia: Hexapodal versus Monorail External Fixation","volume":"103","author":"Chalopin","year":"2017","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1046\/j.1445-2197.2003.02748.x","article-title":"Methodological index for non-randomized studies (minors): Development and validation of a new instrument","volume":"73","author":"Slim","year":"2003","journal-title":"ANZ J. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1016\/j.otsr.2020.06.013","article-title":"Can the TrueLok Hexapod SystemTM Be Used to Accurately Correct Lower Limb Deformity in Children?","volume":"106","author":"Roy","year":"2020","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1097\/BPB.0000000000000573","article-title":"Correction of Complex Lower Limb Angular Deformities with or without Length Discrepancy in Children Using the TL-HEX Hexapod System: Comparison of Clinical and Radiographical Results","volume":"28","author":"Riganti","year":"2019","journal-title":"J. Pediatr. Orthop. B"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/j.otsr.2009.05.005","article-title":"Limb Lengthening and Deformity Correction in Children Using Hexapodal External Fixation: Preliminary Results for 36 Cases","volume":"95","author":"Blondel","year":"2009","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1080\/17453674.2017.1295706","article-title":"Limb Lengthening and Deformity Correction of Congenital and Acquired Deformities in Children Using the Taylor Spatial Frame","volume":"88","author":"Horn","year":"2017","journal-title":"Acta Orthop."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1007\/s00264-004-0611-9","article-title":"The Taylor Spatial Frame for Deformity Correction in the Lower Limbs","volume":"29","author":"Fadel","year":"2005","journal-title":"Int. Orthop. (SICOT)"},{"key":"ref_11","first-page":"816","article-title":"Three-Dimensional Correction of Complex Leg Deformities Using a Software Assisted External Fixator","volume":"74","author":"Docquier","year":"2008","journal-title":"Acta Orthop. Belg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1302\/0301-620X.93B6.25521","article-title":"Complications and Outcome of Tibial Lengthening Using the Ilizarov Method with or without a Supplementary Intramedullary Nail: A case-matched comparative study","volume":"93","author":"Sun","year":"2011","journal-title":"J. Bone Jt. Surgery. Br."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e20","DOI":"10.2106\/JBJS.ST.15.00069","article-title":"Lengthening of the Femur with a Remote-Controlled Magnetic Intramedullary Nail: Retrograde Technique","volume":"6","author":"Fragomen","year":"2016","journal-title":"JBJS Essent. Surg. Tech."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1007\/s11751-013-0163-x","article-title":"Comparison between Lengthening over Nail and Conventional Ilizarov Lengthening: A Prospective Randomized Clinical Study","volume":"8","author":"Emara","year":"2013","journal-title":"Strateg. Trauma Limb Reconstr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1016\/j.otsr.2012.01.007","article-title":"Elastic Intramedullary Nailing as a Complement to Ilizarov\u2019s Method for Forearm Lengthening: A Comparative Pediatric Prospective Study","volume":"98","author":"Jager","year":"2012","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Pietrzak, S., Grzelecki, D., Parol, T., and Czubak, J. (2021). Comparison of Intramedullary Magnetic Nail, Monolateral External Distractor, and Spatial External Fixator in Femur Lengthening in Adolescents with Congenital Diseases. JCM, 10.","DOI":"10.3390\/jcm10245957"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/4\/1091\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:29:33Z","timestamp":1760027373000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/4\/1091"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,8]]},"references-count":16,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["jcm14041091"],"URL":"https:\/\/doi.org\/10.3390\/jcm14041091","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,8]]}}}