Limb shortening in the management of leg length discrepancy
Authors:
Jan Kotaška; Tomáš Trč
Authors‘ workplace:
Klinika dětské a dospělé ortopedie a traumatologie 2. LF UK a FN Motol
Published in:
Čas. Lék. čes. 2016; 155: 417-422
Category:
Review Articles
Overview
Limb shortening is an option to manage leg length discrepancy. Before skeletal maturity, small length discrepancy between 2 and 5 cm can be corrected by open or closed epiphyseodesis or stapling. All these procedures require exact timing of surgery. In skeletally matured patients is shortening of the femur considered safer than tibial shortening. Length discrepancy more than 10 cm should be corrected either by prolongation or one timed procedures concerning shortening osteotomy of longer limb followed with excised bone segment and its implantation in the contralateral limb. Presented review summarizes advantages and disadvantages of both operational concepts (shortening and lengthening) in leg length discrepancy management.
Keywords:
leg length discrepancy, bone shortening, epiphyseodesis, bone prolongation
Sources
1. Tachdijan M. Pediatric ortophaedics, vol. 4. WB Saunders, Philadelphia, 1990: 2850−3012.
2. Ilizarov GA. The tension-stress effect on the genesis and growth of tissues. Part I. The influence of stability of fixation and soft-tissue preservation. Clin Orthop Relat Res 1989; 239: 249−281.
3. Eyre-Brook AL. Bone-shortening for inequality of leg lengths. Br Med J 1951; i: 222−225.
4. Kenwright J. Shortening by bone resection. Semin Orthop 1992; 7: 194−200.
5. Richardson JB, Kenwright J, Cunningham JL. Fracture stiffness measurement in the assessment and management of tibial fractures. Clin Biomech (Bristol, Avon) 1992; 7: 75−79.
6. Siffert RS. Lower limb-length discrepancy. J Bone Joint Surg Am 1978; 69: 1100−1106.
7. Wagner H. [Operative correction of leg length discrepancy]. Langenbecks Arch Chir 1977; 345: 147−154.
8. Broughton NS, Olney BW, Menelaus MB. Tibial shortening for leg length discrepancy. J Bone Joint Surg Br 1989; 71: 242−245.
9. Coppola C, Maffulli N. Limb shortening for the management of leg length discrepancy. J R Coll Surg Edinb 1999; 44: 46−54.
10. Gross RH. Leg length discrepancy: how much is too much? Orthopedics 1978; 1: 307−310.
11. Friberg O. Clinical symptoms and biomechanics of lumbar spine and hip joint in leg length inequality. Spine 1983; 8: 643−651.
12. Guidera KJ, Brinker MR, Kousseff BG et al. Overgrowth management in Klippel-Trenaunay-Weber and Proteus syndromes. J Pediatr Orthop 1993; 13: 459−466.
13. Li Y, Macnicol M. Poland´s syndrome and lower limb length inequality. J Pediatr Orthop 1994; 3B: 459−466.
14. Porat S, Robin GC, Howard CB. Cure of the limp in children with congenital dislocation of the hip and ischaemic necrosis. Fifteen cases treated by trochanteric transfer and contralateral epiphysiodesis. J Bone Joint Surg Br 1994; 76: 463−467.
15. Eichler J. Methodological errors in documenting leg length and leg length discrepancies. Progress Orthop Surg 1977; 1: 29−39.
16. Helms CA, McCarthy S. CT scanograms for measuring leg length discrepancy. Radiology 1984; 151: 802.
17. Synder M, Harcke HT, Bowen JR, Caro PA. Evaluation of physeal behavior in response to epiphyseodesis with the use of serial magnetic resonance imaging. J Bone Joint Surg Am 1994; 76: 224−229.
18. Terjesen T, Benum P, Rossvoll I et al. Leg-length discrepancy measured by ultrasonography. Acta Orthop Scand 1991; 62: 121−124.
19. Greulich W, Pyle S. Radiographic atlas of Skeletal development of the Hand and Wrist. Second Edition. Stanford University Press, Stanford, 1959.
20. Roche AF, Eyman SL, Davila GH. Skeletal age prediction. J Pediatr 1971; 78: 997−1003.
21. Cundy P, Paterson D, Morris L, Foster B. Skeletal age estimation in leg length discrepancy. J Pediatr Orthop 1988; 8: 513−515.
22. Lampe HI, Swierstra BA, Diepstraten AF. Timing of physiodesis in limb length inequality. The Straight Line Graph applied in 30 patients. Acta Orthop Scand 1990; 63: 672−674.
23. Porat S, Peyser A, Robin GC. Equalization of lower limbs by epiphysiodesis: results of treatment. J Pediatr Orthop 1991; 11: 442−448.
24. Anderson M, Green WT, Messner MB. Growth and predictions of growth in the lower extremities. J Bone Joint Surg Am 1963; 45-A: 1−14.
25. Green WT, Anderson M. Experiences with epiphyseal arrest in correcting discrepancies in length of the lower extremities in infantile paralysis; a method of predicting the effect. J Bone Joint Surg Am 1947; 29: 659−675.
26. Green WT, Anderson M. Epiphyseal arrest for the correction of discrepancies in length of the lower extremities. J Bone Joint Surg Am 1957; 39-A: 853−872.
27. Menelaus MB. Correction of leg length discrepancy by epiphysial arrest. J Bone Joint Surg Br 1966; 48: 336−339.
28. Westh RN, Menelaus MB. A simple calculation for the timing of epiphysial arrest: a further report. J Bone Joint Surg Br 1981; 63-B: 117−119.
29. Moseley CF. A straight line graph for leg length discrepancies. Clin Orthop Relat Res 1978; 33−40.
30. Blair VP 3rd, Walker SJ, Sheridan JJ, Schoenecker PL. Epiphysiodesis: a problem of timing. J Pediatr Orthop 1982; 2: 281−284.
31. Stamp WG, Lansche WE. Treatment of discrepancy in leg length. South Med J 1960; 53: 764−774.
32. Guille JT, Yamazaki A, Bowen JR. Physeal surgery: indications and operative treatment. Am J Orthop (Belle Mead NJ) 1997; 26: 323−332.
33. Phemister D. Operative arrest of longitudinal growth bones in treatment of deformities. J Bone Joint Surg 1933; 15: 1−15.
34. Bowen JR, Johnson WJ. Percutaneous epiphysiodesis. Clin Orthop Relat Res 1984; 170−173.
35. Ogilvie JW, King K. Epiphysiodesis: two-year clinical results using a new technique. J Pediatr Orthop 1990; 10: 809-811.
36. Blount WP, Clarke GR. Control of bone growth by epiphyseal stapling; a preliminary report. J Bone Joint Surg Am 1949; 31-A: 464−478.
37. Brockway A, Craig WA, Cockreli BR jr. End-result study of sixty-two stapling operations. J Bone Joint Surg Am 1954; 36-A: 1063−1070.
38. Blount WP. A mature look at epiphyseal stapling. Clin Orthop Relat Res 1971; 77: 158−163.
39. Szepesi K, Rigo J, Poti L, Szucs G. Treatment of leg length discrepancy by subtrochanteric shortening of the femur. J Pediatr Orthop 1990; 10: 183−185.
40. D’Aubigne R. Surgical correction of large length discrepancies in the lower extremities in children and adults. J Bone Joint Surg 1971; 53-A: 411−411.
41. Bianco AJ jr. Femoral shortening. Clin Orthop Relat Res 1978; 49−53.
42. Moore RD. Supracondylar shortening of the femur for leg length inequality. Surg Gynecol Obstet 1987; 84: 1087-1094.
43. Kuntscher G. 25 years of medullary nailing. Zentralbl Chir 1965; 90: 2257−2263.
44. Dewaele J, Fabry G. The timing of epiphysiodesis. A comparative study between the use of the method of Anderson and Green and the Moseley chart. Acta Orthop Belg 1992; 58: 43−47.
45. Gabriel KR, Crawford AH, Roy DR et al. Percutaneous epiphyseodesis. J Pediatr Orthop 1994; 14: 358−362.
46. Kasser JR, Jenkins R. Accuracy of leg length prediction in children younger than 10 years of age. Clin Orthop Relat Res 1997: 9−13.
47. Stephens DC, Herrick W, MacEwen GD. Epiphysiodesis for limb length inequality: results and indications. Clin Orthop Relat Res 1978: 41−48.
48. Bylander B, Hansson LI, Selvik G. Pattern of growth retardation after Blount stapling: a roentgen stereophotogrammetric analysis. J Pediatr Orthop 1983; 3: 63−72.
49. Pilcher M. Epiphyseal stapling: 35 cases followed to maturity. J Bone Joint Surg 1962: 82.
50. Poirier H. Epiphyseal stapling with special reference to complication. J Bone Joint Surg 1968; 50-B: 61−69.
51. Leivseth G, Reikeras O. Thigh muscle atrophy after femoral shortening. Vastus intermedius cross-section studied in osteotomized rats. Acta Orthop Scand 1992; 63: 427−429.
52. Nordsletten L, Holm I, Steen H et al. Bilateral femoral shortening for unaccepted tallness. J Bone Joint Surg Br 1992; 74: 406−408.
53. Kenwright J, Albinana J. Problems encountered in leg shortening. J Bone Joint Surg Br 1991, 73: 671−675.
54. Trč T. Historie terapie zkratu končetin. Stručné shrnutí postupů, řešících nestejnou délku končetin. Ortopedie 2007; 1: 234−238.
Labels
Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain management Dental HygienistArticle was published in
Journal of Czech Physicians
Most read in this issue
- Avascular necrosis of the femoral head
- Femoroacetabular impingement − treatment options
- Rehabilitation after total knee and hip arthroplasty
- Limb shortening in the management of leg length discrepancy