Management of congenital leg length inequality: value of early axis correction

The principles of treatment of congenital leg length inequality include three strategies: joint stabilization, axis correction, and limb length equalization. We believe that early axis correction is important for normal musculoskeletal development and that residual deformity may be self-perpetuating. Of 97 lower limbs assessed, 14 had PFFD alone, 6 fibula hemimelia alone, and 49 a combination of the two. Seventy-four limb segments were operated on, including 29 joint stabilizations, 65 axis corrections, and 62 lengthenings. Axis correction was the commonest procedure in the under-five age group and may be performed alone or in combination with another treatment strategy. The average lengthening achieved was 4 cm representing a 15.75% length increase. The mean bone healing index was 54.25 days/cm, slightly more in the tibia than in the femur. We recommend early axis correction and joint stabilization prior to lengthening. The choice of lengthening technique depends on the preexisting risk factors and lengthenings should be short and frequent.