Distraction osteogenesis allows for gradual elongation of foreshortened extremities and/or correction of bone deformities, with the aims of restoring alignment and improving function and appearance. Although distraction osteogenesis technique and its principles could well be applied to several pediatric upper-limb conditions that require functional improvements through an increase of bone and soft-tissue length, the majority of the literature has described applications and its outcomes in lower limb deformities. This may be partly due to high complication rate of upper extremity procedure. Despite they do not have the same functional significance, problems encountered during lengthening of the upper limb are similar to those complicating lower limb lengthening. This review article focuses on the technical issues, results, and possible complications associated with bone-lengthening procedures in the pediatric upper extremity.