Prevention of Complications in Limb Lengthening Surgery: Evidence-based Strategies for Minimizing Pin Site Infections, Joint Contractures, and Neurovascular Injuries

Abstract

Limb lengthening and deformity correction surgery utilizing external fixation devices represents complex orthopedic interventions associated with substantial complication risks. This narrative review examines evidence-based prevention approaches for the most common complications: pin site infections, joint contractures, neurovascular injuries, delayed bone consolidation, and psychological distress. We synthesize available evidence to provide actionable prevention protocols rather than merely describing complications. Key prevention strategies include standardized pin site care protocols with normal saline cleaning 2–3 times weekly, intensive physiotherapy programs emphasizing differential lengthening principles to prevent muscle–bone length discrepancy, careful preoperative anatomic planning with nerve-specific risk mitigation, bone stimulation techniques for patients at high risk of delayed union, and structured psychological support programs. Evidence suggests that systematic implementation of these prevention bundles can reduce complication burden while improving functional outcomes, though the quality of comparative effectiveness data remains limited. Critical gaps identified include the need for randomized trials comparing specific prevention protocols, validated risk prediction models, and long-term outcome data linking prevention strategies to functional results. This review provides orthopedic surgeons and limb reconstruction teams with prioritized, evidence-based prevention recommendations essential for optimizing patient outcomes in this challenging surgical specialty.