Limb-Length Discrepancy in Children


In children, differences in the lengths of the right and left legs can have effects ranging from cosmetic concerns to severe impairment of mobility. Such differences can be acquired, congenital, or developmental, and can be static or progressive. Growth to skeletal maturity can amplify differences occurring from gestation through adolescence, and several methods can be used to predict limb-length discrepancy at skeletal maturity. A thorough history, physical examination, and radiographic examination are keys to the diagnosis of limb-length discrepancy. Options for treating such discrepancies include nonsurgical treatment, limb shortening through epiphysiodesis or bone resection for discrepancies of 2 to 5 cm, and limb lengthening through distraction osteogenesis for discrepancies exceeding 5 cm. This presentation discusses the contraindications, principles, procedures and equipment, advantages and pitfalls, complications, and postoperative rehabilitation for two types of percutaneous epiphysiodesis, osteotomy for acute limb shortening, and distraction osteogenesis for limb lengthening.

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