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The most important recent advance in limb lengthening is the recognition that bone will regenerate, under appropriate conditions, within the gap of an osteotomized bone. Although Codivilla recognized this phenomenon, bone formation was inconsistent in his patients. Optimal distraction osteogenesis requires a knowledge of osteotomy techniques, length of latency period, rate and frequency of distraction, and mechanical effects of loading.

The discipline of limb lengthening has undergone numerous advances in recent years. An increased understanding of the biology of distraction osteogenesis, as well as technical advances, has made lengthening more feasible. However, significant problems remain unsolved, and complications--although less severe and long standing--still remain. Little is known about the effect of distraction on soft tissues. Lengthening in skeletally mature patients remains difficult. The myriad of conditions that require lengthening often confounds comparison of techniques. Uniform indications for limb lengthening may never exist, but increasing experience helps guide patient selection.