Limb shortening for the management of leg length discrepancy

Limb shortening is an option to manage leg length discrepancy (LLD). Before skeletal maturity, a LLD between 2 and 5 cm can be corrected by epiphyseodesis (open or closed) or stapling. All these procedures require exact timing of surgery. In skeletally mature patients, shortening of the femur is considered safer than tibial shortening. Subtrochanteric and supracondylar osteotomies fixed with a blade-plate can be used to correct associated deformity. Mid-shaft shortening can be performed by a closed or open method. Closed shortening has been widely used, but frequent malrotation, loss of function and acute respiratory distress syndrome following reaming have been reported. Therefore, the use of a nail locked proximally and distally, and caution in reaming the canal, are strongly recommended. For LLDs greater than 10 cm, lengthening should be considered, although a one-stage two-limb procedure can be used, whereby shortening is performed on the longer limb, and the excised bone segment is implanted in the contralateral limb to be lengthened. However, when shortening procedures are performed in skeletally immature patients, they require precise timing, and indications and technical details must be strictly observed.