Page 2 - Patient inclusion criteria

All patients were evaluated by an expert medical team who examined the impact of short stature on the patient’s everyday life, and how they might cope with difficulties encountered during treatment. Actual and perceived problems related to short stature were also taken into account. Difficulties in daily work and life, driving motorcycles or large bicycles were also considered. Functional limitations of short stature were considered a valid and good motivation for gaining height surgically. Patients requested surgery particularly for professional reasons, such as military or police career, models, and business people who felt uncomfortable in meetings etc. due to their short stature.

Regarding height distribution, the normal bell curve was considered, and patients were divided as shown in Table 1. Normal height was considered ±3 standard deviations (SD) from the mean. A stature below 3SD in patients without dwarfism and/or skeletal deformities was considered as a constitutional short stature. The lower limit of normal stature for Caucasian people was 50500 (166 cm) for males and 50000 (153 cm) for females.

All patients who underwent cosmetic leg lengthening were under the 5th percentile for age and gender, and without any dwarfism and/or skeletal deformities or hormonal deficiencies. A detailed history of all previous aesthetic interventions was included to exclude dysmorphophobia [5–7].

Psychological evaluation of all patients and their families, anthropometrical measurements with particular attention to the proportions of the limbs and trunk, and radiological examination for deformity and/or leg length discrepancy were performed. Patients were also informed about the duration of treatment and all the possible complications during surgery and after removal of the frame. Informed consent was obtained from all patients. Patients who accepted to undergo surgery were also invited to discuss their treatment with at least two other patients before and after surgery.

In cases of deformity and leg discrepancy, simultaneous correction was also obtained. Patients and methods
The study was performed according to the ethical standards of the Declaration of Helsinki (1964) and its later amendments. From January 1985 to December 2010 the medical records of 63 patients with constitutional short stature (36 males, 27 females for a total of 126 legs) who underwent cosmetic bilateral leg lengthening using a hybrid advanced fixator according to the Ilizarov method, were reviewed retrospectively [4, 8, 9]. The mean age was 24.8 years (range 17–48 years; 27.8 for males and 22.9 for females) while the mean preoperative height was 152.6 cm (range 140–172 cm; 154.4 cm for males and 145.2 cm for females). Eight patients also had varus knee deformity which required correction during treatment. All patients practiced noncompetitive sports.

Preoperative clinical/radiographic evaluation and surgical planning were performed for all patients. Paley’s criteria were used to evaluate complications for this procedure, including postoperative assessment of all problems, obstacles and complications from the time of surgery until 1 year after removal of the frame [8].

Problems were defined as any potential difficulties arising during the treatment period and fully resolved by the end of the process by non-operative means. Pin track infection, docking drift, wound breakdown, and delayed consolidation were included in this category.

Obstacles were defined as any potential difficulties arising during the treatment period and fully resolved by the end of the process by operative means. Non-union, joint contracture, atrophic or fracture through regenerated bone, axial deviation, leg length discrepancy, equinus, and early fibular consolidation were included in this category.

Complications were defined as any local or systemic complication (intraoperative/postoperative) or difficulty found during the stretching or stabilization that remained unresolved until the end of the treatment period, and any early or late difficulty observed after treatment. Persistent knee contraction, amputation due to non-union/poor regenerate bone or persistent infection, reflex sympathetic dystrophy and neurological disturbances were included in this category [10].