Limb length discrepancy Dr Omer Barawi

LIMB LENGTH DISCREPANCY (ANISOMELIA)

It is a common orthopaedic problem arising from either shortening or
overgrowth of one or more bones in the limb.
LLD can be described as either too long (+) or too short (-), which may be
the sole deformity (pure LLD) or it may be associated with angulation,
rotation or translation deformities i.e.it is three dimensional, while in
growing child there is fourth dimension of the deformity which TIME.
How LLD will affect:
1. With fast walking ACKWARD* gait will be resulted, while running will be
difficult impossible.*moving or behaving in a way that does not seem
relaxed or cofortable.
2. Backache in long standing cases.
3. Early degenerative changes in lower limb joints.
4. Increased energy expenditure.

Historical Land makes achieved in the treatment of LLD :

Codvilla ( 1905 ),first publication osteotomy, traction with plaster cast.
Magnuson
Ombredanne ( 1912 ).
Alaln ( 1948 ).
Gavril Abramovig ILLIZAROV ( 1951 ) Distraction histogenesis , tension
stress effect, Ring external fixator.
Wagner ( 1971 ). Monolateral external fixator.
De-Bastiani ( 1986 ) Italy, Chondrodaistasis. Using Orthofix external
fixator with ball and joints .
Dror Paley and Herzenberg , Lenthening over a nail and external
fixator.

Causes of LLD:

1. Trauma can cause growth retardation like Salter Harris Type five
epiphyseal plate injuries during childhood , diaphyseal fractures with
marked overriding of fragments. Trauma can cause growth
stimulation also especially in diaphyseal operations of long bones
when there is stripping of the periosteum.
2. Paralysis like Poliomyelitis and cerebral .
3. Tumors and tumor like conditions.
4. Infection can cause growth retardation like epiphyseal plate
destruction due to osteomyelitis ,septic arthritis or granulomatous
arthritis of TB.
5. Congenital,like Developmental Dysplasia of Hip DDH ,Club foot
,Fibular Hemimelia , Congenital Coxa vara and Proximal Focal
Femoral Deficiency.
6. Others like Legg-Calve-Perthes' disease and Slipped Upper Femoral
Epiphysis.
ASSESSMENT : The simplest way of measuring limb length
discrepancy is to place wooden blocks of known heights under the
short leg till the pelvis is level however asymmetrical pelvic
development or pelvic obliquity may cause miscalculation. By using
tape measure from anterior superior iliac spine to the medial malleolus
is another method but this does not include foot height.
Roentgenographic technique by standing orthoroentgenogram and
Scanogram are two imaging techniques.
TREATMENT of limb length discrepancy can be done by: shoe rising
of the shorter limb if the discrepancy is 2.5 cm, epiphysiodesis of the
longer limb, shortening of the long leg and lengthening of the short
leg. The program requires patient and family full committed to
maximal participation in an extend project. The patient and his parent
benefit from meeting other patients in various stages of lengthening.
Difficulties of LLD :
Problems, Obstacles , Minor and Major Complications according to Dror
Paley's method.