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Management of leg length inequality.
1Shriners Hospitals for Children, Philadelphia, PA 19140, USA.
Journal of the Southern Orthopaedic Association
|July 23, 2002
Summary
Leg length inequality is common and requires careful assessment. Treatment guidelines vary based on the severity of the inequality, ranging from shoe lifts to surgical interventions like epiphysiodesis or lengthening procedures.
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Skeletal Dysplasias
Background:
- Leg length inequality (LLI) is a prevalent condition affecting musculoskeletal health.
- Effective management aims to achieve limb length equalization, pelvic balance, and functional improvement.
Purpose of the Study:
- To outline clinical and radiographic assessment methods for LLI.
- To present evidence-based treatment guidelines for LLI based on the degree of discrepancy.
Main Methods:
- Clinical assessment involves evaluating pelvic levelness using adjustable blocks.
- Radiographic evaluation includes teleroentgenogram, orthoradiograph, and computed tomography (CT).
- Prediction of LLI at skeletal maturity guides treatment decisions.
Main Results:
- Treatment is stratified based on LLI severity: <2 cm (no treatment/lift), 2-6 cm (epiphysiodesis/shortening), 6-15 cm (lengthening).
- Significant LLI (15-20 cm) may necessitate staged lengthening, combined procedures, or amputation.
- Limb lengthening procedures carry a high frequency of complications, even with expert execution.
Conclusions:
- Accurate assessment and prediction of LLI are crucial for appropriate management.
- Established guidelines provide a framework for treating LLI, balancing efficacy with potential risks.
- Awareness of complication rates associated with limb lengthening is essential for patient counseling and surgical planning.