Your doctor will consider several things when planning your child's treatment, including:
. The size of the discrepancy
. Your child's age
. The cause of the discrepancy, if known
For patients with minor limb length discrepancies (less than 1 inch) and no deformity, treatment is usually nonsurgical in nature. Because the risks of surgery may outweigh the benefits, surgical treatment to equalize small differences in leg length is not usually recommended.
Read more about : Limb Length Discrepancy
Read more about : Leg lengthening surgery
Nonsurgical treatments may include:
. Observation. If your child has not yet reached skeletal maturity, your doctor may recommend simple observation until growing is complete. During this time, your child will be reevaluated at regular intervals to determine whether the discrepancy is increasing or remaining the same.
. Wearing a shoe lift. A lift fitted to the inside or outside of the shoe can often improve a patient's ability to walk and run. A shoe lift may also relieve back pain caused by a smaller limb length discrepancy. Shoe lifts are inexpensive and can be removed easily if they are not effective.
Read more about : Leg Lengthening Surgery Complications and Risks
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In general, surgeries for limb length discrepancy are designed to do one of the following:
. Slow down or stop the growth of the longer limb
. Shorten the longer limb
. Lengthen the shorter limb
In children who are still growing, epiphysiodesis can be used to slow down or stop growth at one or two growth plates in the longer leg.
It is a relatively simple surgical procedure that can be performed in one of two ways:
. The growth plate may be destroyed by drilling or scraping it to stop further growth. The leg length discrepancy will gradually decrease as the opposite leg continues to grow and "catch up."
. Metal staples, or a metal plate with screws, may be placed around the sides of the growth plate to slow or stop growth. The staples are then removed once the shorter leg has "caught up."
The procedure is performed through very small incisions in the knee area, using x-rays for guidance. Proper timing is critical. The goal is to reach equal leg length by the time growth normally ends—usually in the mid to late teenage years.
Read more about : Internal Limb Lengthening Surgery
About Iranian Surgery
Iranian surgery is an online medical tourism platform where you can find the best orthopedic Surgeons in Iran. The price of limb length discrepancy treatment in Iran can vary according to each individual’s case and will be determined based on photos and an in-person assessment with the doctor.
For more information about the cost of limb length discrepancy treatment in Iran and to schedule an appointment in advance, you can contact Iranian Surgery consultants via WhatsApp number +98 901 929 0946. This service is completely free.
Disadvantages of epiphysiodesis include:
. The possibility of a slight over- or under-correction of the limb length discrepancy
. The patient's adult height will be less than if the shorter leg had been lengthened
. Correction of a significant discrepancy using this technique may make the patient's body look slightly disproportionate because of the shorter leg
. Limb Shortening
In patients who are finished growing, the longer limb can sometimes be shortened to even out the leg lengths.
To do this, the doctor removes a section of bone from the middle of the longer limb, then inserts metal plates and screws or a rod to hold the bone in place while it heals.
Because a major shortening may weaken the muscles of the leg, limb shortening cannot be used for significant limb length discrepancies. In the femur (thighbone), a maximum of 3 inches can be shortened. In the tibia (shinbone), a maximum of 2 inches can be shortened.
. Limb Lengthening
Because of their complexity, limb lengthening procedures are usually reserved for patients with significant discrepancies in length.
Lengthening can be performed either externally or internally.
. External lengthening. In this procedure, the doctor cuts the bone in the shorter leg into two segments, then surgically applies an "external fixator" to the leg. The external fixator is a scaffold-like frame that is connected to the bone with wires, pins, or both.
The lengthening process begins approximately 5 to 10 days after surgery and is performed manually. The patient or a family member turns the dial on the fixator several times each day.
When the bones are gradually pulled apart (distracted), new bone will grow in the space created. Muscles, skin and other soft tissues will adapt as the limb slowly lengthens.
The bone may lengthen 1 mm per day, or approximately 1 inch per month.
Lengthening may be slower in a bone that was previously injured. It may also be slower if the leg was operated on before. Bones in patients with potential blood vessel abnormalities, such as cigarette smokers, may also need to be lengthened more slowly.
The external fixator is worn until the bone is strong enough to support the patient safely. This usually takes about three months for each inch of growth. Factors such as age, health, smoking and participation in rehabilitation can affect the amount of time needed.
Read more about : Leg lengthening surgery cost 2021
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External limb lengthening requires:
. Meticulous cleaning of the area around the pins and wires
. Diligent adjustment of the frame several times daily
Potential risks and complications of external lengthening include:
. Infection at the site of wires and pins
. Stiffness of the adjacent joints
. Slight over- or under-correction of the bone's length
. Internal lengthening. In this procedure, the doctor cuts the bone in the shorter leg, then surgically implants an expandable metal rod in the bone. The rod is completely internal and lengthens gradually in response to the normal movements of the patient's limb.
As the rod lengthens, the bones are gradually pulled apart and new bone grows in the space created. The rod provides stability and alignment to the bone as it lengthens.
Because no external fixator is used in internal lengthening, there is less risk of infection—including the superficial infection that commonly occurs around pin sites.
Internal lengthening avoids the physical and psychological challenges that come with wearing an external fixator; however, it allows for less precise control over the rate of lengthening.
Both internal and external lengthening take several months to complete. Both procedures require:
. Regular follow-up visits to the doctor's office
. Extensive rehabilitation, including physical therapy and home exercise
A doctor experienced in limb lengthening techniques will talk with you about your treatment options and explain the risks and benefits of both internal and external limb-lengthening. Together, you and your doctor will decide which procedure, if any, is best for your child.