Procedure Description

Limb Lengthening

The process of lengthening the bones in the arms or legs is known as "limb lengthening." This is done gradually so that the soft tissues (skin, muscles, nerves, etc.) and bones grow longer over time. The procedure usually takes many months. It is also possible to combine acute or progressive deformity repair with limb lengthening. The humerus (upper arm bone), radius/ulna (forearm), femur (thigh bone), tibia (shin bone), and metatarsals (foot bones that impact toe length) are all regularly lengthened at the International Center for Limb Lengthening.

Disease Overview

limb length discrepancy

A condition known as limb length inequality, or limb length discrepancy (LLD), occurs when one arm or leg is shorter than the other.

Compared to disparities in leg length, which affect daily activities like walking and playing sports, variances in arm length are less likely to affect normal function. Leg length variations can range

greatly, from less than an inch to several inches. Notable variations may have an impact on a person's walking or standing posture. This could result in issues with the ankle, knee, and hip as well

as scoliosis, an abnormal curving of the spine.

LLD is classified as either a progressive or static deformity:

1. Static: The difference remains constant. This might be the result of a malunion of a lower limb bone fracture, which occurs when a broken bone heals in an unusual way.

2. Progressive: When the difference gets bigger, it may get worse. This could be the result of a growth plate injury or a congenital (born with a disease) ailment.

Disease Sign and Symptoms

Leg length disparity symptoms vary depending on the source of the difference in leg length and whether additional medical issues are present.

Among the symptoms are:

1. Issues with one's gait, or way of walking, such as a limp, tiptoeing, or slanting to one side

2. An abnormal posture, such as a tipped shoulder or a persistently hyperextended ankle on the shorter leg

3. Ankle, knee, hip, or back pain brought on by the body correcting for the leg length differential.

4- Functional scoliosis, or improper spinal curvature

5- Back discomfort

6- Arthritis in the bones

Disease Causes

Leg length disparities may occur from birth. These might have unknown causes, or they could be caused by diseases such developmental dysplasia of the hip (DDH) that affect how the hips

align.

There are other reasons for the difference in leg length.

1. Damage to the bones: Growth of the bone may be impacted by fractures or other injuries. For instance, a bone that has suffered repeated fractures and significant muscle and skin injury may

mend more quickly than it did initially. Nonetheless, a child's leg bone may occasionally grow more quickly than the bone in the other leg due to accelerated growth. This is more typical of small

children who have thigh bone fractures.

2. Bone infection: Osteomyelitis, a bone infection, can harm the growth plate and cause disparities in limb length.

3. Bone tumors: Treatment for bone tumors can alter the rate at which bones grow, resulting in variations in length.

4. Neuromuscular conditions: Disparities in alignment and posture can result from paralyzing illnesses such as cerebral palsy.

Disease Diagnosis

Leg length disparity in children is sometimes initially seen by parents. In order to correctly diagnose children with this problem, a pediatric orthopedist will:

1. Review the child's medical background

2. Conduct a physical examination, taking note of the child's posture, gait, and other habits.

3. If the child is old enough to walk, conduct a gait study to evaluate how they walk and see whether they adjust their gait to make up for a difference in leg length.

There are various methods to measure the difference in limb length, including: 

1- Measuring the limbs when the infant is laying at rest

2. After the hips are level, place a row of blocks under the shorter leg and measure the height of the blocks.

Imaging tests can be suggested in order to measure the difference in limb length more precisely. In order to prescribe the right course of action, this aids your doctor in determining the problem's cause or origin.

These could consist of one or more of the subsequent:

1. X-rays to show the leg bones in clear detail

2. Scannogram (a kind of X-ray that measures leg bone length with three images and a ruler)

3. To better observe the bone and soft tissue and determine the cause, use magnetic resonance imaging (MRI) or computed tomography (CT) scans.

Disease Treatment

The etiology, severity, and age of the kid will all influence the course of treatment for leg length disparity. Most of the time, using a raise or insert in one shoe helps rectify slight variations in leg length. If there are noticeable variations in leg length, surgery might be necessary to stop more problems. Surgical interventions could involve:

1. Epiphysiodesis: To limit or halt the growth of the longer leg in children who are still growing, this treatment may be advised. This permits the shorter limb to grow to its full length.

 Little incisions are made all around the knee to accomplish the surgery. When the child's growth ceases in their mid-to-late teens, it is timed so that the leg lengths are equal.

2. Limb shortening: For individuals with less noticeable differences in leg length, this is a possibility. A section of the lengthier limb's middle bone is removed during this treatment. To keep the bones in place while they recover, a metal rod or plate is placed.

3. Limb lengthening: Patients with notable disparities are typically the only ones who have this operation. It could be carried out internally or outside. For all types, substantial rehabilitation including physiotherapy is necessary after several follow-up visits to the doctor to check treatment progress.

4. External lengthening: This procedure entails removing the shorter leg's bone and inserting a frame, sometimes referred to as an external circular-ring fixator, that is fastened to the bone with wires or pins. By turning the frame by hand, the bones are gradually separated, making room for new bone to grow. Until the newly developed bone is strong enough to support the patient, the frame is worn. To avoid infection, the pins must be carefully maintained and cleaned during this period.

5. Internal lengthening: In a similar vein, internal lengthening entails severing the shorter leg's bone. By surgically implanting an expandable metal rod that is gradually lengthened, the bones are pulled apart, making room for new bone to form. Although the procedure could take several months, there is a reduced risk of wound complications.

Country wise cost comparison for Limb Lengthening: