Lengthening beyond 25% of the original segment length is an orthopaedic challenge. Substantial lengthening is fraught with complications such as joint contractures, refractures, nerve injuries and prolonged periods of consolidation. We report a case of massive lengthening in a 17-year-old boy in whom a 20 cm lengthening (57% lengthening) and complex deformity correction was performed on a centralized fibula using the Ilizarov technique, with an excellent result. A total of 17 months were taken to complete the process of lengthening and consolidation at a healing index of 0.85 months/cm. Besides a minor pin tract infection, there were no major complications. We believe that with meticulous pre operative planning and follow-up the extent of lengthening can be extended in cases of severe limb length discrepancy.
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