Abstract
INTRODUCTION: Short stature, defined as height below the 3rd percentile for age and gender, affects approximately 200 million people worldwide. It can have profound psychological effects, influencing self-esteem, social interactions, and overall life satisfaction, particularly during adolescence. These individuals often face challenges in both professional and romantic lives, increasing their risk of depression and suicidal ideation. Surgical interventions such as limb lengthening can provide life-changing results for individuals facing psychological distress due to short stature. This meta-analysis reviews the literature on cosmetic stature surgery, focusing on Paley outcomes and psychosocial satisfaction, and compares external fixation (EF) and intramedullary nailing (IMN) techniques. METHODS: This study adhered to PRISMA guidelines. Eligibility criteria included studies with more than five patients, the use of the Paley classification for outcome assessment, and a focus on cosmetic limb lengthening with either EF or IMN. Data from PubMed were extracted using standardized forms and analyzed for complication rates, functional outcomes, and psychosocial satisfaction. The Paley complication system categorized problems, obstacles, and complications, and risk of bias was assessed using the STROBE checklist. Data synthesis was performed using JAMOVI software with effect size and confidence interval calculations. RESULTS: Seven studies were included, with a total of 489 patients undergoing EF or IMN for cosmetic limb lengthening. Procedure-related mortality was zero across all studies. EF was associated with higher rates of Paley problems (56 %), obstacles (48 %), and complications (10 %) compared to IMN, which had 37 % problems and 42 % obstacles, with no significant complications reported. Patient satisfaction was generally high, with EF studies reporting satisfaction rates of up to 95 %. CONCLUSION: EF and IMN are both viable options for cosmetic limb lengthening. While EF may present more complications, it maintains high patient satisfaction, whereas IMN offers a safer profile with fewer complications. A collaborative approach, combining surgical options with psychosocial and psychiatric support, can help individuals achieve improved physical and emotional well-being.