Leg Length Discrepancy > 5 cms - POSNA

posted on 02 Nov 2013 20:05 by upsetapex9552
Leg Length Discrepancy > 5 cms - POSNA
Leg length discrepancy (> 5 cms)ObjectivesDiscuss the methods available to treat leg length discrepancies of > 5 cmsDiscuss the process of lengthening, including expected time in external fixation to achieve lengtheningDiscuss complications of bone lengthening procedures
Discussion pointUnder what circumstances might amputation afford better functional results than a lengthening procedure?
Largely as a result of the clarification of biologic principles involved in lengthening by Ilizarov, the capability of the orthopaedist to reliably lengthen limbs has increased dramatically in the last 20 years.These include surgical preservation of the blood supply to the bone, a distraction rate of 1 mm/day, divided incrementally, and a period of several days delay after osteotomy before commencing lengthening.As a result, the horizons of lengthening have exponentially broadened, and we are still in a period of assessment of how much is possible and at what cost. It is clear that "straight forward" lengthening procedures following traumatic or infectious physeal injuries do very well.It is clear that lengthenings of dysplastic bones or bones with congenital shortening do not do quite as well, for a number of reasons.Congenital shortening is accompanied by various degrees of joint and ligamentous instability, predisposing to dislocation and shortening of muscle-tendon units which increase the technical difficulties of maintaining alignment while lengthening. Neuorpraxia or more permanent deficits have been reported, particularly involving the peroneal nerve. Results following lengthening for fibular hemimelia have been especially sobering.
The lengthening index is a method of estimating the time required in external fixation to achieve a certain amount of length. A reasonable lengthening index is 40 days per cm length gained, so a 5 cm lengthening would require 200 days in a fixator.Ring, monolateral, and hybrid fixators are currently in usage.In general, results of lengthening are much more gratifying than they were 20 years ago.Controversy still prevails for entities such as the already mentioned fibular hemimelia, and pseudoarthrosis of the tibia, where a tibia of sufficient strength to maintain its integrity without external support is difficult to achieve.

This is a very dynamic field with further refinements in technique constantly being investigated.

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