My Orthopaedic Surgeon

Objectives
1. Discuss the rationale for treating leg length discrepancy of> 2 cms
2. Discuss methods available for treatment of leg length discrepancies in the 2-5 cm range
3. Discuss complications resulting from treating leg length discrepancy in the 2-5 com range

Objectives
1. Describe physical exam methods useful for assessment of leg length discrepancy, including potential causes of error with each method.
2. List imaging studies available for quantifying leg length discrepancy. Discuss accuracy and radiation dose for each method.
3. Describe the functional effects of smaller amounts of leg length discrepancy (<2.5 cms) on posture, incidence of back pain, development of scoliosis, and functional capability.
4. Discuss methods used for predicting leg length discrepancy at skeletal maturity, including possible causes of error.

Accuracy and precision of clinical estimation of leg length inequality and lumbar scoliosis: comparison of clinical and radiological measurements. Int Disabil Stud. 1988; 10(2):49-53 (ISSN: 0259-9147) Friberg O; Nurminen M; Korhonen K; Soininen E; Mänttäri T Research Institute of Military Medicine, Central Military Hospital, Helsinki, Finland. The results of 196 clinical determinations of leg length inequality and postural pelvic tilt scoliosis in 21 patients were analysed and compared with reliable radiological measurements. Clinical methods proved to be inaccurate and highly imprecise, the observer error being +/- 8.6 mm for direct and +/- 7.5 mm for indirect measurement of leg length inequality, and +/- 6.4 degrees for the estimation of postural lumbar scoliosis. More than half (53%) of the observations were erroneous when the criterion of leg length inequality was 5 mm. Failure to determine the presence or absence of length inequality of more than 5 mm occurred in 54 measurements (27% of the total). In 12% of the direct and in 13% of the indirect measurements, the observers erred in deciding which leg was longer; discrepancies occurred even when radiological reading gave a leg length inequality of as much as 25 mm.

Objectives
1. Discuss the methods available to treat leg length discrepancies of> 5 cms
2. Discuss the process of lengthening, including expected time in external fixation to achieve lengthening
3. Discuss complications of bone lengthening procedures

Notes on limb length inequality Wheeless Textbook of Orthopaedics

Management of Leg Length Inequality from Journal of the Southern Orthopaedic Association James J. McCarthy, MD, and G. Dean MacEwen, MD Abstract Leg length inequality is common. Treatment objectives include obtaining leg length equality, producing a level pelvis, and improving function. Clinical assessment should include determination of a level pelvis with the patient standing using a set of blocks of various heights to estimate the amount of leg length inequality. Radiographic measures include the teleroentgenogram, orthoradiograph, and computed tomography (CT). A prediction of the ultimate leg length inequality at skeletal maturity will be needed to determine treatment. Our guidelines for treatment of leg length inequality are as follows: <2 cm -- no treatment or a lift in the shoe; 2 to 6 cm -- an epiphysiodesis or shortening procedure is considered; 6 to 15 cm -- a lengthening procedure is considered. A leg length inequality of 15 to 20 cm -- may require a staged lengthening, lengthening combined with epiphysiodesis, or amputation. Numerous complications of limb lengthening procedures occur frequently, even in experienced hands. Medscape

Case Study - Medscape