When your child has a leg discrepancy and needs limb lengthening, it is important to visit your physician early while your child is still growing. If you take advice to wait, you may miss out on a window of opportunity to avoid a big surgery by doing more simple surgery.
Some conditions are better treated early while growth potential is still possible.
Limb length discrepancies can be present at birth or may develop during childhood. Up to 80 percent of human beings may have different leg lengths, and 80 percent of those may not even realize it. When the discrepancy is larger than a couple of inches, however, this can create problems. Discrepancy may stay the same or may worsen and increase as they child grows.
The physicians at Medical City Children’s Orthopedics & Spine Specialists can determine the severity of a limb length discrepancy by a simple clinical exam or by X-rays with a low radiation EOS machine of the extremities. This evaluation is often repeated, sometimes every six months, to monitor the limb length difference in growing children.
The decision to treat a limb length discrepancy depends on the amount of difference there will be when the child stops growing. Not all discrepancies need to be treated. For those that do, treatment type is determined by the amount of difference expected at maturity. 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 catch up. If the discrepancy is more than three inches, we discuss lengthening operations on the shorter leg. Limb lengthening is a surgical procedure used to lengthen bones or replace segments of missing bone in the upper and lower extremities. One approach is to insert a rod into the bone that will also gradually lengthen the bone after creating a fracture during surgery. This lengthening is done using an external magnetic control.
Early treatment is recommended with limb lengthening issues
“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
Limb lengthening and reconstruction techniques can be used to replace missing bone and lengthen and/ or straighten deformed bone segments. The procedures may be performed on children who have limb length discrepancies due to birth defects, diseases or injuries. The limb lengthening and deformity correction process works on the principle of distraction osteogenesis. This is a revolutionary concept that reverses the long-held belief that bone cannot be regenerated.
In this process, a bone that has been cut during surgery can be gradually distracted (pulled apart), leading to new bone formation (osteogenesis) at the site of the lengthening. In this way, bone segments can be lengthened by 15 to 100 percent of their original length. We use a variety of techniques, including the use of monolateral (one-sided) and circular external fixation devices, to correct angular deformities as well as limb length discrepancies. The regenerated bone is normal and does not wear out. The muscles, nerves and blood vessels grow in response to the slow stretch like they do during a growth spurt.
The actual procedure is minimally invasive and requires only one or two nights in the hospital. Patients aren’t in much pain since the distraction is so gradual and patients can continue to walk during the treatment. Children with congenital deformities such as fibular hemimelia, congenital short femur and hemiatrophy will often have unequal leg length and this may be associated with deformity. Many adults have had this condition since childhood and have developed back pain and hip arthritis from the leg length discrepancy. Growth plate fractures and bone infections in children can cause stunting of growth that results in discrepancy. Following trauma, bones can heal in a shortened and deformed position (mal-union). Sometimes the bone can even remain unhealed (non-union). Limb lengthening procedures address all of these issues. We can successfully correct large deformities and equalize limbs with discrepancies of several inches. A segment of bone can be missing after a bone tumor, bone infection or severe fracture. We can transport new bone to fill in this defect.
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