by Mr Nicholas Peterson, Consultant Trauma and Orthopaedic Surgeon
Alfie Phillips, born with the rare condition fibular hemimelia, which meant his right leg was significantly shorter than his left, has undergone the UK’s first extramedullary limb lengthening procedure.
Until recently, lengthening options for children with this condition were limited due to the bone being too small for an intramedullary lengthening nail, with an external fixator used as the standard treatment. In March 2025, specialists at Liverpool’s Alder Hey Children’s Hospital implanted an extramedullary motorised telescopic nail outside Alfie’s femur. The device is gradually lengthened using a magnetic mechanism three times daily, promoting natural bone growth. The procedure achieved a 3 cm increase in the length of Alfie’s femur, reducing his limb length difference to less than 1cm.
Alfie described the experience as transformative:
“I can do a lot of things I couldn’t do before, like skipping, basketball, and trampolining. I’m now taller than my friend!”
Mr Nick Peterson, Consultant Orthopaedic Surgeon and expert witness, explained the significance of the technique:
“Internal lengthening is less painful and provides a much better overall experience than lengthening with an external fixator. Previously, this method was not available for younger children as their bones are too narrow and they have open growth plates. Following extramedullary lengthening, Alfie’s recovery has been remarkable, and his case paves the way for this technique to replace external fixators for other children in the UK.”
Alfie spent less than a week in hospital and continued physiotherapy throughout the lengthening process. His mother, Laura Ducker, praised his resilience:
“He coped magnificently and was keen to return to school quickly. He is running around as normal—if you looked at him, you’d never know anything had happened.”
Since Alfie’s pioneering surgery, the procedure has been successfully performed on three other children in Alder Hey, as well as in Sheffield, and other specialist centres across the UK are preparing to adopt the method.
You can read the BBC article in full here.
Mr Nicholas Peterson’s profile can be viewed in full here.