Type of Surgery

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Last updated: 11/24/2009

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A LLD of 0.8 in (2 cm) or less is usually not a functional problem and non-surgical treatment options are preferred. The simplest forms do not involve surgery:

  • Orthotics. Often leg length can be equalized with a sole or heel lift attached...

    to or inserted inside the shoe. This measure can effectively level a difference of 0.4–2.0 in (1.0–5.0 cm) and correct about two thirds of the LLD. Up to 0.4 in (1 cm) can be inserted in a shoe. Beyond this, the lift gets heavy, awkward, and can cause problems such as ankle sprains and falls. The shoes look unsightly and patients complain of gait instability with such a large lift. A foot-in-foot prosthesis can be used for larger LLDs but they tend to be bulky and used as a temporary measure.
  • Physical therapy. LLD results in the pelvis tilting sideways since one side of the body is higher than the other side. In turn, this causes a "kink" in the spine known as a scoliosis. Thus, leg length discrepancies can alter the mechanics of the pelvis so that the normal stabilizing and controlling action of specific muscles is altered. A common approach is to use exercises designed to modify the mechanics through specific strengthening of muscles that are weak and stretching of muscles that are restricting movement.

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These twin sisters are undergoing leg lengthening treatment. Their mother turns bolts on the external fixators of the leg to increase the distance between the two parts of the the surgically broken bone 1 millimeter a day. (Custom Medical Stock Photo. Reproduced by permission.) These twin sisters are undergoing leg lengthening treatment. Their mother turns bolts on the external fixators of the leg to increase the distance between the two parts of the the surgically broken bone 1 millimeter a day. (Custom Medical Stock Photo. Reproduced by permission.)




To lengthen a leg surgically, an incision is made in the leg to access the femur (A). A surgical drill is used to weaken the femur so the surgeon can break it. During the operation, screws are drilled into the bone on both sides of the break, and an external fixator is applied (B). The gap between the two pieces of bone is increased gradually (C), so new bone growth results in a longer leg (D). (Illustration by GGS Inc.) To lengthen a leg surgically, an incision is made in the leg to access the femur (A). A surgical drill is used to weaken the femur so the surgeon can break it. During the operation, screws are drilled into the bone on both sides of the break, and an external fixator is applied (B). The gap between the two pieces of bone is increased gradually (C), so new bone growth results in a longer leg (D). (Illustration by GGS Inc.)




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Other Information

Leg lengthening and shortening are types of surgery to treat children who have legs of unequal lengths, usually with differences of 1 inch or more.

These procedures may:

Lengthen an abnormally short leg

Shorten an abnormally long leg

Limit growth of a normal leg to allow a short leg to grow to a matching length

BONE LENGTHENING

Lengthening an abnormally short leg may be recommended for children whose bones are still growing. This series of treatments involves several surgical procedures, a lengthy convalescence period, and considerable risks -- but it can add up to 6 inches of length to a leg.

While the child is under general anesthesia, the bone to be lengthened is cut. Metal pins or screws are inserted through the skin and into the bone.

Pins are placed above and below the cut in the bone, and the skin incision is stitched closed.

A metal device (usually some sort of external frame) is attached to the pins in the bone and will be used later to gradually pull the cut bone apart, creating a space between the ends of the cut bone that will fill in with new bone. The lengthening device is used very gradually to ensure adequate filling of the bone and stretching of the soft tissues.

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.

Because the pins or screws are inserted through the skin into the bone, special care of the pin sites is important to prevent infection. Also, because the blood vessels, muscles, and skin are stretched with each lengthening, careful and frequent checking of the skin color, temperature, and sensation of the foot and toes is necessary to prevent circulatory, muscular, or nerve damage.

BONE SHORTENING

Shortening a longer leg may be recommended for children whose bones are no longer growing. This is a technically complicated surgery that can produce a very precise degree of correction.

While the child is under general anesthesia, the bone to be shortened is cut and a section of bone is removed. The ends of the cut bone will be joined and a metal plate with screws or a nail down the center of the bone is placed across the bone incision to hold it in place during healing.

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 necessary to prevent circulatory, muscular, or nerve damage.


From http://www.nlm.nih.gov/medlineplus/ency/article/002965.htm

Other Information

Orthopedic complaints are the most common reason to seek medical care.


From: About.com

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