Pediatric Limb Lengthening Surgery
Limb lengthening is a very specialized surgical skill, and only surgeons who are trained in limb lengthening should perform the operation. More people trust Children’s for their child’s orthopedic surgery than any other pediatric hospital in the U.S*.
At Children’s, our pediatric orthopedic surgery team understands how to properly lengthen bones in growing teens and kids. Our Orthopedics Program is the only nationally ranked orthopedics program for kids and teens in Georgia, and the top-ranked program for kids and teens in the Southeast*. And we have expertise in limb lengthening, as well as an experienced comprehensive limb difference team to take care of your child. Our surgeons are highly involved in limb lengthening research, presenting regularly at national and international medical meetings.
Limb lengthening surgery is a treatment for major limb length discrepancies (often greater than 2 inches) in a child’s bone. The reconstruction focuses on straightening the bone (if crooked) in addition to making it longer. These procedures can improve function and enable your child to walk without a large shoe lift or prosthesis.
If the bone is lengthened too fast, it may not heal, and the surrounding muscles, nerves and joints may be at risk for permanent damage. If the bone is lengthened too slowly, it may heal too quickly, and the bone may not be able to reach its desired length.
What devices or tools are used in limb lengthening surgery?
There are two types of devices that our pediatric and deformity-trained orthopedic surgeons use during a limb lengthening surgery at Children’s:
Your child’s doctor will talk to you about the benefits of each device. In addition, your doctor may prescribe special orthotics (custom fit shoes, shoe lifts, braces or splints) as an option for your child.
Besides limb lengthening, are there other surgical options?
Options for surgery may include:
- Lengthening or shortening of fingers and smaller bones
- Straightening of bones and fingers
- Amputation
- Repositioning of bones and fingers
- Transfer of fingers and toes
- Targeted muscle innervation
The Comprehensive Limb Difference Program at Children’s includes pediatric orthopedic surgeons, as well as pediatric physical therapists, prosthetists and orthotists to help make sure your child’s limbs remain as functional as possible.
Our surgeons contribute to limb lengthening and limb deformity research groups, like Limb Lengthening and Reconstruction Society and Association of Children’s Prosthetic-Orthotic Clinics. Our doctors’ contributions to research aim to improve outcomes for limb lengthening patients, helping to reduce time spent in the hospital or complications after surgery. Our team presents at medical meetings nationally and internationally so that families around the world can benefit from the standard of care created at Children’s.
Contact our Comprehensive Limb Difference Program
- Phone: 404-785-6353
- Email: limbdifference@choa.org
Our Limb Lengthening Surgeons
- Jorge A. Fabregas, MD, Co-Lead, Comprehensive Limb Difference Program
- Jill C. Flanagan, MD, Co-Lead, Comprehensive Limb Difference Program; Medical Director, Osteogenesis Imperfecta Program
- Robert W. Bruce Jr., MD, Medical Director, Neuromuscular Program and Cerebral Palsy Program
- Dana Olszewski, MD, MPH, Clinical Site Education Director
- Dell C. McLaughlin, MD, MPH
- Michael L. Schmitz, MD
Specialists in Our Comprehensive Limb Difference Program
Physiatrist
Contact: 404-785-KIDS (5437)
Physical therapists
Contact: 404-785-5684
- Colleen P. Coulter, PT, DPT, PhD, PCS
- Jill Cannoy DT, DPT, PCS
Prosthetists
Contact: 404-785-3229
- Brian Giavedoni, MBA, CP, LP
- Rebecca Hernandez, CPO, LPO
- Richard Welling, MSPO, CPO, LPO
- Brian Emling, PO, LPO
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What to Expect: Adjusting Your Child’s Orthofix Device
In this video, you’ll learn how to adjust your child’s Orthofix device between appointments.
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What to Expect: Adjusting Your Child’s Orthex Device
In this video, you’ll learn how to adjust your child’s Orthex device between appointments.
Find answers to parents’ most common questions about their child’s limb lengthening surgery.
There are many factors that affect how much a bone can be lengthened. Generally, a bone can safely be lengthened by 20%. For example, if a bone is 10 inches, it could safely be lengthened by 2 inches.
Prior to your child’s limb lengthening surgery, our surgeon will work with your family to determine a goal length for the bone. On average, an external fixator will remain in place for one month for every centimeter of lengthening. For example, if the goal is to lengthen your child’s limb by 5 centimeters (2 inches), the external fixator will need to stay on for five months.
There are risks with limb lengthening. Tightness around the hip, knee and ankle are relatively common with lower extremity lengthening. At Children’s, we have developed a specific postoperative physical therapy protocol designed to decrease stiffness during lengthening. In addition, your child's surgeon may recommend your child wear a brace at night to decrease the risk of joint tightness. Typically, once lengthening is complete, the range of motion of the joints improves.
The most serious risk is a joint dislocation. The knee or hip can dislocate during a lengthening procedure. Children with congenital (present at birth) femoral deficiency are at much higher risk for a joint dislocation. This can be prevented with weekly X-rays and intensive physical therapy to maintain range of motion. It’s important to work with your child’s care team.
Your child’s doctor will talk to you about all of the risks involved with the surgery. Our surgical team takes many precautions to help ensure the safety of each patient. We have expertise in limb lengthening and an experienced comprehensive limb difference team to take care of your child.
Everyone has a different experience with pain during limb lengthening treatment. In general, the first inch added during treatment is relatively easy, but additional inches can be more painful for kids. Our team uses several ways to manage pain. Your child’s surgeon will work with you to create a pain management plan.
While your child is undergoing limb lengthening treatment, the surgeon will typically see your child on a weekly or biweekly basis to help ensure the limb is lengthening properly.
Your child's surgeon will give you and your child very specific instructions on how to use their internal lengthening nails or external fixator device. It is very important to follow these instructions carefully. Adjusting the devices too fast or too slow can be dangerous and lead to complications.
Your child should start physical therapy immediately after surgery. Arrangements for physical therapy will be made prior to surgery if possible. Children’s physical therapists are trained in the physical therapy protocol for your child’s limb lengthening treatment.
Our team is trained and has developed a postoperative protocol. If a Children’s physical therapist is not located near you, we will provide your physical therapist with our physical therapy limb lengthening protocol. Your physical therapist should provide reports with updates on your child’s range of motion of the hip, knee and ankle joints. It is important to bring a copy of this report to every follow-up visit with your child's surgeon.
Showering or bathing daily is the best way to decrease the risk of infection once surgical dressings are removed. Typically, the surgical dressings stay in place for one week after surgery. If the wounds look clean, the surgeon will typically allow your child to take a shower one week after surgery and a bath two weeks after surgery.
Sometimes, pins that are loose or under a lot of stress are at an increased risk of infection. If the pin is slightly loose, let your child’s surgeon know right away. You can also wrap rolled gauze tightly around the loose pin and another pin to help keep it stable. Once limb lengthening or deformity correction is completed, the risk of pin infections decreases.
Signs of an infection at the pin site include:
- Increased redness around the pin site
- Increased pain around the pin site
- New drainage around the pin site
If you notice any of these symptoms, contact your child’s doctor. If your child has a fever higher than 100°F, call the doctor right away. This could be a sign of a more serious infection that may need to be treated in the hospital.
More Information About Pediatric Limb Lengthening
** Pediatric Health Information System (2025), as prepared by the Children’s Hospital Association. This report compares clinical data annually for more than 47 pediatric hospitals in the U.S.
* No. 15 on the U.S. News & World Report “Best Children’s Hospitals” list for 2026-27.