Forty-five limb lengthening procedures are carried out in the Orthopedic department in Alkhadra Hospital in Tripoli the period between April 2006 and December 2010A retrograde study done Subjects and Methods A scanogram was used for measurement. All our cases

operated under general anesthesia. One bone at a time, for the tibia, we used the tourniquet. Distal or midshaft fibular osteotomy: If it was distal, we fix the distal segment to the tibia by a single screw for ankle stability. Two Schanz screws were inserted in the metaphyseal region above the proposed corticotomy site, another two screws just below it. As all our cases had proximal metaphyseal osteotomy, one skin incision was used, and two parallel periosteal incisions were performed. Gigli saw was used with or without drill holes, safeguarding the medulla. The Wagner apparatus was then installed. The wound was closed in layers over the drain. An antibiotic was given postoperatively; check if an x-ray was taken. On the second postoperative day, lengthening started and was recorded on the chart. In the other group the corticotomy was kept compressed for two weeks, and lengthening started in the same manner. We lengthen 1 mm per day, monitoring the patient's response. Some patients were taught how to use the apparatus on themselves, though most of the patients remained in the hospital until full length was achieved. Control x-ray prior to discharge unless complications were detected. Once the target length had been achieved, the frame was locked until a good quality of bone was seen radiologically; then the fixator was removed. All patients underwent vigorous physiotherapy from the first postoperative day Results from 45 patients include 10 males (22%) and 35 females (78%). Twenty-seven tibiae (60%), seventeen femora (37%), and one humerus were lengthened (3%). Lengthening ranged between 3 cm (18%) and 11 cm (3%). The cause of lengthening was residual poliomyelitis in 38 patients (84%), trauma in 4 patients (9%), and congenital shortening in 3 patients (7%). Complication: Only 5 cases (11%) had pin tract infection; malalignment of the longitudinal axis more than 5 degrees was noticed in 12 cases (27%); equinus deformity was noticed in 9 cases (20%) of tibial lengthening; and knee stiffness was observed in 11 cases (24%) of both femoral and tibial lengthening. There was neither serious infection nor deep venous thrombosis. With such an extended course of treatment, most of the patients had some problems that resolved with nonoperative intervention. Most patients experienced pain or discomfort during The course of treatment was managed by analgesics or by stopping the length for 1-2 days. Conclusion: In all patients the desired length was gained without any serious mechanical problems.