Pediatric Orthopedic surgeons Limb Lengthening

ARM AND LEG LENGTHENING FOR CHILDREN

The medical team at Medical City Children’s Orthopedics & Spine Specialists has vast expertise in unique and special Arm and Leg Lengthening procedures. Parents should bring their children to us as soon as the discrepancy is noticed.  Then we can correct the condition and your child can run, play and act as all kids do.

Some leg lengthening and arm lengthening conditions are better treated early while growth potential is still possible.

Arm and leg Lengthening for Children – Height Growth Operations

Leg LengtheningArm and leg lengthening for children refer to a surgical procedure.  This procedure increases the length of a shorter limb for symmetrical growth and to enhance gait and function. It provides a corrective procedure when your child has a notable difference in the lengths of their arms or legs. Differences in leg or arm length can lead to nerve damage, dislocations, joint contractures, and muscle damage amongst others. The procedures, performed by orthopedic surgeons, will ensure your child’s limbs become the same length while getting perfect care.

At Medical City Children’s Orthopedics and Spine Specialists, we believe every child is different and special; so we ensure that each case provides the correct solutions with accuracy and precision. Our successes in height growth operations and arm and leg lengthening procedures for children and adolescents have been recognized globally. Dr. Shyam Kishen leads the team and his peers consider him as a leading expert in this field.

What are the Causes of Variation in Arm and Leg Length?

Some of the most common causes of discrepancies in limb length:

  • Birth defects like Congenital bowing of the tibia bone
  • Trauma to Growth Plates
  • Illnesses like Polio
  • Bone Infection
  • Bone Diseases like Neurofibromatosis
  • Joint Inflammations like Juvenile Arthritis

In the case of dwarfism, it causes short stature, limb deformities of different kinds, and functional limitations. Height growth and arm and leg lengthening in children’s operations can correct some of the abnormalities.

Previous injury to one of the bones in the leg

Leg fracture can cause differences in the length of legs if the affected leg heals in a shortened position. This usually happens if the bone breaks into many pieces, or if a compound fracture occurs — where the bone breaks through the skin and muscle tissue around the affected bone gets badly injured.

In a child, a fractured bone sometimes grows faster for many years after it heals, thereby making it grow longer than the bone on the other leg. In addition, this form of overgrowth usually occurs in young children with thighbone fractures.

A fracture occurring in a child’s growth plate — near the end of the bone — may cause slower growth, thereby leading to a shorter leg.

Bone infection

A bone infection that occurs in growing children can lead to a significant difference in limb length. Furthermore, this usually occurs if the infection occurs in infancy.

Dysplasias (bone disease)

Some bone diseases can lead to discrepancies in arm or leg length. Such diseases include:

  • Multiple hereditary exostoses
  • Neurofibromatosis
  • Ollier disease

Bone diseases can also lead to knock knees. Knock knees usually develop in most children around the age of 3 and they often grow out of it between the ages of 8 and 9 years.

Other causes include:

  • Conditions like joint inflammation during growth (such as juvenile arthritis)
  • Neurological conditions

These conditions are often found at birth, but the difference in the length of the limb may be too insignificant for a doctor to notice early on. As the child grows, the difference in length increases and it becomes noticeable. In such cases, one of the two bones found between the knee and the ankle becomes abnormally short.  Also, foot or knee problems may also cause leg length differences in children.

How Are Arm and Leg Length Differences Diagnosed?

Most of the time parents or the child’s pediatrician recognize these limb differences. Once determined, the parents will see a pediatric orthopedic surgeon who will verify the differences and the severity. The first step in diagnosing limb length variation and severity occurs with the help of an x-ray or a simple clinical examination. The tests usually occur once every six months to monitor the differences and determine the right time for any limb lengthening procedure.

Physical examination

The doctor will ask about the child’s health, medical history, and what symptoms exist. The doctor will then carry out a detailed examination while observing how the child sits, stands, and moves.

The physical examination involves:

Gait analysis

The doctor will observe the child’s gait (i.e. how the child walks). Children can compensate for differences in the length of the leg by walking on their toes or flexing their knees.

Measurement of leg discrepancy

While the child stands without shoes, the doctor will measure the discrepancy by placing wooden blocks under the short leg to make the hips level.

Imaging studies

X-rays

An X-ray shows images of bones. If the doctor wants a precise measurement of the discrepancy, he or she will request X-rays of the child’s legs.

Scanograms

This type of X-ray measures the length of the bones in the legs by using a series of three images and a ruler. The doctor may need a scanogram in addition to an X-ray.

Computerized tomography (CT) scans

These help to provide a more detailed image of the soft tissues and bones in the legs. The doctor usually uses the CT scan to measure the discrepancy in the limb length.

As the child grows, the doctor may conduct further physical examinations and imaging studies every six months to one year to learn if the differences progress or remain the same.

When Should You Consider Arm or Leg Lengthening Surgery for Children?

Treatment of limb length discrepancies depends on the variance in the length of the arms or legs. Not all limb length variations require surgery or treatment. However, if the difference becomes very obvious and limiting, doctors will recommend treatment as soon as possible — especially for young children.

What are the Limb Lengthening for Children Treatment Options?

Doctors recommend several options for limb lengthening and height growth operations, but a child may require more than one treatment option to get the best result. At Medical City Children’s Orthopedics and Spine Specialists, our specialists evaluate your child’s situation and determine which options to use. By the way, while many believe that doctors only lengthen the legs, doctors also lengthen arms

Gradual Limb Lengthening for Children and Deformity Correction

This treatment option involves mounting an external fixator on a limb to lengthen or shorten it or repair a deformity. External fixators are of two types; circular rings that go round the exterior of the limb and a straight bar along one side of the limb. The fixator frame remains on the outside of the limb and connects to the bone through pins and screws.

Once the surgeon puts the fixator in place, the surgeon then performs an osteotomy which divides the bone. The doctor decides as to where to divide the bone upon carefully evaluating the patient and the type of correction needed.

After the conclusion of the arm or leg lengthening surgery, the surgeons at Medical City Children’s Orthopedics & Spine Specialists show the parents how to adjust the fixator on their child’s limb. In addition, parents will adjust the fixator daily so the two parts of the divided bone can gradually move into their new and correct position to lengthen the limb and increase the height of the child.

New bone grows in the gap between the two ends of the cut bone and over time, the bone heals enough so that the fixator can get removed from the limb by a quick procedure.

Epiphysiodesis

As mentioned earlier, a special layer of cartilage at each end of a bone is referred to as a growth plate and it allows the bone to grow. When a child reaches adulthood, the growth plate becomes bone and at this point, the bone no longer grows.

This Epiphysiodesis process slows down the growth of a bone. By performing surgery, the surgeon will remove the growth plate of the longer limb. Upon the growth plate being removed from the longer limb, the shorter leg can catch up with the longer one over time. Only children who continue to grow should get this procedure. By the time your child stops growing, both limbs should become the same length.

Normally, surgeons conduct this surgery when a child is between the ages of 10 and 14. It also depends on the differences in limb length. Epiphysiodesis works well for very little limb differences. Doctors consider this procedure a relatively simple, one-day procedure.

After the procedure, your child can put his or her full weight on the leg almost immediately and he or she will not require a cast but will need crutches for about a week or two. Regular follow-up appointments and X-rays should occur to monitor the success of the operation.

Hemiepiphysiodesis

This process pertains to straightening a deformed or crooked bone as a child grows. During a procedure, the doctor attaches a small metal plate to the growth plate at the end of the deformed bone. This slows down the growth of one side of the bone allowing the other side to grow faster — straightening the limb.

The procedure occurs as an outpatient and your child will not feel the metal plate and it can only be seen via an x-ray. Regular follow-up appointments and x-rays are scheduled to allow the surgeon to keep tabs on the crooked limb and the straightening over time.

Usually, complete straightening takes about 6 to 12 months and once the bone has been straightened completely, the small metal plate gets removed to prevent curving to the other direction. The hemiepiphysiodesis process does not work on all limb deformities, and therefore, our doctors will thoroughly examine the patient to determine eligibility.

Acute Deformity Correction

Reconstruction surgery can correct some limb deformities. In addition, this procedure fixes the deformity in a single surgery without requiring gradual correction. When your child is aroused from anesthesia, the limb is already straightened.

With this option, the surgeon divides the bone and then holds it together in the right place using metal plates, screws, or rods. After surgery, your child will need to refrain from putting weight on the operated limb and stop any lifting of heavy things. Additionally, your child will also need crutches for about 6 to 12 weeks and participate in physical therapy. Note, that this is a one-time surgery that does not require further procedures.

Limb Shortening

This procedure involves reducing the length of the longer limb. Doctors consider this procedure for patients with limb length differences of about 2 to 5 cm. This procedure helps people who have completely stopped growing or are near the end of growing.

If the child does not qualify for epiphysiodesis and you do not want your child to undergo a limb lengthening or height growth operation, this procedure may provide positive results.

The surgery removes a length of bone from the longer limb and uses a rod or metal plate to hold the bone together. This will make both legs equal.

Although this surgery appears as the perfect solution for certain limb discrepancies, it could come with specific issues that your doctor will fully explain. With this operation, physical therapy must take place and it could take a year or more for the shortened limb to regain its former strength.

Highly Rated Doctors

Medical City Children’s Orthopedics and Spine Specialists comprises only board-certified and fellowship-trained orthopedic surgeons. With successful limb lengthening for children and height growth operations (specifically for children), we are the right doctors to take care of your child and all their limb needs. The hospital takes pride in providing the very best of care available for your child.

Patient Reviews

When you read the patient reviews of the Medical City Children’s Orthopedics and Spine Specialists, you will learn how much trust the parents have for our doctors. When choosing a doctor to help with very unique procedures, parents should read all the reviews to discover what previous patients think of our expertise.  Our parents and patients love us for a reason and you will too.

Top-Notch Facilities and Equipment

Our doctor will operate on your child at the Medical City Hospital. Finally, Medical City Hospital provides the best care available and we take pride in keeping up to date with new and improved equipment to ensure the increased success rate of each procedure.

Our Specialists Are Here for You

Our compassionate pediatric orthopedic specialists are committed to providing children with arm or leg length discrepancies with a customized treatment plan.  We use cutting-edge techniques, proven procedures, and cutting-edge techniques that produce positive outcomes for better health. We use different surgical techniques to treat different limb conditions. Apart from routine limb lengthening, our pediatric orthopedic specialists treat joint contractures and other complications that cause limb length differences.

In conclusion, contact us today to learn more about your child’s arm or leg lengthening procedure. Call 972-576-7838 to schedule a free appointment with one of our specialists or to receive an answer to any and all of your questions.

 

 

Leg Lengthening

We recommend early treatment for children and adolescents with one leg much shorter than the other

“When the discrepancy is warranted, we may recommend using guided growth where we help tether the growth plate to slow down the long leg to allow the short leg to catch up. If the discrepancy is more than three inches, we discuss lengthening operations on the shorter leg.” Shyam Kishan, MD

 

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