Leg lengthening and shortening are types of surgery to treat some children who have legs of unequal lengths.
These procedures may:
BONE LENGTHENING
This series of treatments involves several surgical procedures, a long recovery period, and a number of risks -- but it can add up to 6 inches of length to a leg.
While the child is under general anesthesia:
Later, when the leg has reached the desired length and has healed (usually after several months), another surgical procedure will be done to remove the pins.
BONE RESECTION OR REMOVAL
This is a complicated surgery that can produce a very precise degree of correction.
While the child is under general anesthesia:
BONE GROWTH RESTRICTION
Bone growth takes place at the growth plates (physes) at each end of long bones.
While the child is under general anesthesia, the surgeons make a surgical cut over the growth plate at the end of the bone in the longer leg.
REMOVAL OF IMPLANTED METAL DEVICES
Metal pins, screws, staples, or plates may be used to stabilize bone during healing. Most orthopedic surgeons prefer to wait several months to a year before removing any large metal implants. Removal of implanted devices requires another surgical procedure using general anesthesia.
Leg lengthening is considered for large differences in leg length (more than 5 cm or 2 inches). Leg lengthening is more likely to be recommended:
Leg shortening or restricting is considered for smaller differences (less than 5 cm or 2 inches). Shortening a longer leg may be recommended for children whose bones are no longer growing.
Bone growth restriction is recommended for children whose bones are still growing. It is used to restrict the growth of a longer bone, while the shorter bone continues to grow to match its length. Proper timing of this treatment is important to ensure good results.
Medical illnesses that lead to severely unequal leg lengths include the following:
Risks for any anesthesia include:
Risks for any surgery include:
Additional risks include:
After bone growth restriction:
After bone shortening:
After bone lengthening:
Because the blood vessels, muscles, and skin are involved, careful and frequent checking of the skin color, temperature, and sensation of the foot and toes is important. This will help identify any damage to blood vessels, muscles, or nerves as early as possible.
Bone growth restriction (epiphysiodesis) is usually successful when it is performed at the correct time in the growth period. However, it may cause short stature.
Bone shortening may achieve more exact correction than bone restriction, but it requires a much longer recovery period.
Bone lengthening is completely successful only 40% of the time, and has a much higher rate of complications.
Epiphysiodesis; Epiphyseal arrest; Correction of unequal bone length; Bone lengthening; Bone shortening; Femoral lengthening; Femoral shortening
Beaty H. Congenital anomalies of the lower extremity. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier;2007:chap 26.
Hosalkar HS, Gholve PA, Spiegel DA. Leg-length discrepancy. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 675.
Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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