Page 6 - Discussion Continued
Two patients in the series of Catagni et al. had delayed consolidation of regenerate in which autologous bone graft was used. We did not need to use bone graft in any of our patients. In two of our patients with unsatisfactory progress of consolidation after 3 months of the maturation phase, we applied two crossed olive wires across the regenerate from proximal to distal connected to the apparatus through slotted, threaded rods in gentle traction which is thought to stimulate maturation. Catagni et al. also reported deformity of the regenerate after fixator removal in three patients and which they corrected with reapplication of the Ilizarov frame. We tried using plaster casts for correction and reapplied the fixator only if the correction was unsatisfactory. Catagni et al. reported one patient had a limb length discrepancy greater than 1 cm whereas none of our patients had a length discrepancy. They also reported minor complications with eight patients having axial deviation less than 5 degrees, five patients with subtalar stiffness, and two patients with limited ankle dorsiflexion.

Catagni et al. reported that all their patients felt satisfaction, improvement in self-esteem, distress, shyness, and quality of life, although they also did not seem to have used any validated score. Their functional outcome score was based on patient satisfaction, axial deviation, ROM, pronation of the foot, leg length discrepancy, and scarring, and they reported an excellent outcome in 49 patients (91%) and good outcome in five (9%).

Distraction osteogenesis using the Ilizarov external fixator is an option for carefully selected patients with short stature motivated to have an increase of height. The patients must be made aware of the nature of the technique and all possible complications. Many soft tissue and bonerelated complications including those that necessitate reinterventions should be expected during the course of treatment, and patients must be monitored and followed up carefully. Most of these challenges can be managed without much permanent sequelae and disability. Future studies with more robust methods and rigorous statistical analysis will need to determine whether the risks and benefits of this procedure are well balanced and establish safe limits of cosmetic lengthening. In all situations of cosmetic limb lengthening, the surgeon must counsel the patient - keeping in mind the ethical issues the surgery can raise - to critically examine whether it is worth taking such risks for the anticipated benefit. The surgeon must always keep the safety of the patient the main priority over the numerical values of height gained. Our center is dedicated to the Ilizarov technique, therefore studies from other centers will be important as we move forward with this technique.

Acknowledgments
We thank Irina A. Saranskih MA, International Department, Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, for facilitating the study by translating relevant information between Russian and English.


References On Following Page.