Arlette Blasl
All the knowledge I possess everyone else can acquire, but my heart is all my own.
Apparent Leg Length Discrepancy Measurement
Overview


There are many different conditions in childhood and adult life that can lead to deformity of a limb or difference in leg lengths. Treatment for these conditions depends on the condition being treated, the age of the child and the amount of deformity or shortening. Generally, only a final difference of leg length of 2cm or more requires surgical treatment. An outline of treatment options is given below.Leg Length Discrepancy


Causes


There are many causes of leg length discrepancy. Structural inequality is due to interference of normal bone growth of the lower extremity, which can occur from trauma or infection in a child. Functional inequality has many causes, including Poliomyelitis or other paralytic deformities can retard bone growth in children. Contracture of the Iliotibial band. Scoliosis or curvature of the spine. Fixed pelvic obliquity. Abduction or flexion contraction of the hip. Flexion contractures or other deformities of the knee. Foot deformities.


Symptoms


If your child has one leg that is longer than the other, you may notice that he or she bends one leg. Stands on the toes of the shorter leg. Limps. The shorter leg has to be pushed upward, leading to an exaggerated up and down motion during walking. Tires easily. It takes more energy to walk with a discrepancy.


Diagnosis


Leg length discrepancy may be diagnosed during infancy or later in childhood, depending on the cause. Conditions such as hemihypertrophy or hemiatrophy are often diagnosed following standard newborn or infant examinations by a pediatrician, or anatomical asymmetries may be noticed by a child's parents. For young children with hemihypertophy as the cause of their LLD, it is important that they receive an abdominal ultrasound of the kidneys to insure that Wilm's tumor, which can lead to hypertrophy in the leg on the same side, is not present. In older children, LLD is frequently first suspected due to the emergence of a progressive limp, warranting a referral to a pediatric orthopaedic surgeon. The standard workup for LLD is a thorough physical examination, including a series of measurements of the different portions of the lower extremities with the child in various positions, such as sitting and standing. The orthopaedic surgeon will observe the child while walking and performing other simple movements or tasks, such as stepping onto a block. In addition, a number of x-rays of the legs will be taken, so as to make a definitive diagnosis and to assist with identification of the possible etiology (cause) of LLD. Orthopaedic surgeons will compare x-rays of the two legs to the child's age, so as to assess his/her skeletal age and to obtain a baseline for the possibility of excessive growth rate as a cause. A growth chart, which compares leg length to skeletal age, is a simple but essential tool used over time to track the progress of the condition, both before and after treatment. Occasionally, a CT scan or MRI is required to further investigate suspected causes or to get more sophisticated radiological pictures of bone or soft tissue.


Non Surgical Treatment


Treatment of leg length inequality involves many different approaches, such as orthotics, epiphysiodesis, shortening, and lengthening, which can be used alone or combined in an effort to achieve equalization of leg lengths. Leg length inequality of 2 cm or less is usually not a functional problem. Often, leg length can be equalized with a shoe lift, which usually corrects about two thirds of the leg length inequality. Up to 1 cm can be inserted in the shoe. For larger leg length inequalities, the shoe must be built up. This needs to be done for every shoe worn, thus limiting the type of shoe that the patient can wear. Leg length inequalities beyond 5 cm are difficult to treat with a shoe lift. The shoe looks unsightly, and often the patient complains of instability with such a large lift. A foot-in-foot prosthesis can be used for larger leg length inequalities. This is often done as a temporizing measure for young children with significant leg length inequalities. The prosthesis is bulky, and a fixed equinus contracture may result.


Leg Length Discrepancy


Surgical Treatment


Lengthening is usually done by corticotomy and gradual distraction. This technique can result in lengthenings of 25% or more, but typically lengthening of 15%, or about 6 cm, is recommended. The limits of lengthening depend on patient tolerance, bony consolidation, maintenance of range of motion, and stability of the joints above and below the lengthened limb. Numerous fixation devices are available, such as the ring fixator with fine wires, monolateral fixator with half pins, or a hybrid frame. The choice of fixation device depends on the desired goal. A monolateral device is easier to apply and better tolerated by the patient. The disadvantages of monolateral fixation devices include the limitation of the degree of angular correction that can concurrently be obtained; the cantilever effect on the pins, which may result in angular deformity, especially when lengthening the femur in large patients; and the difficulty in making adjustments without placing new pins. Monolateral fixators appear to have a similar success rate as circular fixators, especially with more modest lengthenings (20%).
Comments
Comments
Comment is pending approval.
Comment is pending blog author's approval.
2017/05/07 (日) 04:06:35 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2017/05/07 (日) 05:07:26 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2017/05/07 (日) 10:44:19 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2017/05/07 (日) 12:00:08 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2017/05/08 (月) 16:28:12 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2017/05/09 (火) 20:21:56 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2017/05/25 (木) 12:27:21 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2017/06/05 (月) 21:34:07 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2017/07/11 (火) 11:23:22 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2017/07/25 (火) 03:47:34 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2017/07/28 (金) 15:39:34 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2017/07/31 (月) 05:45:23 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2017/09/17 (日) 03:17:39 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2017/10/08 (日) 23:54:13 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2017/10/14 (土) 09:19:00 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2017/10/27 (金) 07:52:47 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2017/11/23 (木) 04:44:13 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2017/11/29 (水) 02:39:07 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2017/12/13 (水) 21:38:33 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2017/12/18 (月) 20:54:41 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2018/01/06 (土) 22:03:29 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2018/01/15 (月) 17:32:40 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2018/03/19 (月) 01:58:38 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2018/05/19 (土) 14:49:10 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2018/05/20 (日) 13:31:39 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2018/05/31 (木) 04:48:42 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2018/06/01 (金) 21:24:44 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2018/06/02 (土) 01:02:36 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2018/06/02 (土) 11:42:42 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2018/06/03 (日) 02:08:36 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2018/06/03 (日) 12:12:16 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2018/06/04 (月) 04:58:57 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2018/06/04 (月) 07:57:08 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2018/06/05 (火) 13:24:08 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2018/06/05 (火) 16:24:13 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2018/06/05 (火) 19:53:31 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2018/06/06 (水) 09:19:52 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2018/06/06 (水) 10:39:07 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2018/06/08 (金) 07:57:12 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2018/06/09 (土) 14:48:35 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2018/07/15 (日) 17:46:29 | | #[ Edit ]
Comment is pending approval.
Comment is pending blog author's approval.
2018/07/24 (火) 10:56:05 | | #[ Edit ]
Post a comment
URL:
Body:
Edit password:
Private comment: Only the blog author may view the comment.
 
Trackbacks
Trackbacks URL
Trackbacks
copyright © 2018 Arlette Blasl all rights reserved.
Powered by FC2 Blog.