Complications of distraction osteogenesis: a changing pattern

We reviewed Mr. Simpson's first 80 consecutive limb-lengthening procedures, using either a circular or a unilateral frame, and analyzed the complication rates. The initially high complication rate (100%) decreased significantly (P < .01) with experience. Incidence of axial deviation was reduced by changing the configuration of the fixators; delayed consolidations and fractures were reduced by prophylactic bone-grafting and by minimizing the associated complication of muscle contractures; severe pin-track infection was reduced by introducing a simple protocol; and muscle contractures and joint subluxation were reduced by adjusting the bone screw insertion sites and ensuring adequate early analgesia to allow early movement.