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Extensive Bone Lengthening for a Patient with Linear Morphea.

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Localized scleroderma, or morphea, can cause leg length discrepancy in children. This case study shows extensive bone lengthening surgery successfully improved mobility despite complications.

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Area of Science:

  • Orthopedics
  • Pediatric Surgery
  • Dermatology

Background:

  • Localized scleroderma (morphea) is a rare connective tissue disorder.
  • Linear scleroderma is the most common subtype in children, often affecting limbs.
  • It can cause significant leg length discrepancy (LLD) due to bone dysplasia and atrophy.

Observation:

  • A pediatric patient with extensive linear scleroderma presented with substantial LLD.
  • The patient underwent two stages of simultaneous femur and tibia lengthening using external fixators.
  • Complications included regenerate fracture during the first femoral lengthening.

Findings:

  • Despite a healing index exceeding 100 days/cm (except for the initial femoral lengthening), the patient achieved independent ambulation without assistive devices.
  • A residual LLD of 38 mm was noted at the final follow-up.
  • The case highlights the challenges of limb lengthening in patients with compromised soft tissue and regenerative capacity.

Implications:

  • Limb reconstruction surgery, specifically extensive bone lengthening, can be a viable option for correcting LLD in pediatric linear scleroderma.
  • Careful surgical planning and management are crucial to mitigate risks such as regenerate fracture and malalignment.
  • Further research into optimizing surgical outcomes and managing soft tissue complications in these patients is warranted.