Elongation Shinbones Surgery 10 Cms Bilateral

Limb Length Discrepancy Treatment  

Limb length discrepancy (LLD) is a medical condition typified by difference in the length of one leg or arm due to either congenital (present at birth) as a result of developmental abnormalities or acquired later in life due to factors such as trauma, infections, or diseases.  This discrepancy can cause various functional problems and physical discomfort including gait abnormalities, where the individual may limp or have difficulty walking, and compensatory issues such as hip, knee, or lower back pain due to uneven stress distribution on the body.  

In Cuba treatment for LLD is carried out by a multidisciplinary medical team including well-trained and highly skilled orthopedic surgeons.  Treatment options include non-surgical approaches or surgical options depending on the severity of the discrepancy, the age of the patient, and the underlying cause.  

The benefits of LLD treatment are significant, particularly in preventing long-term complications such as:  

• Gait Abnormalities. 

• Chronic Pain. 

• Joint Problems. 

• Spinal Issues. 

• Functional Limitations. 

• Psychological Effects.  

Types of Limb Length Discrepancy  

Limb Length Discrepancy (LLD) can generally be classified into two main types: structural LLD and functional LLD.   

• Structural (True) LLD: This type of LLD is when there is length difference in the bones of the limbs due to variations in the growth or development of the bone itself.  

• Functional (Apparent) LLD: Functional LLD occurs when the limbs are equal in length, but due to other factors, such as issues related to muscle, joint, or alignment problems, they function as if there is a length discrepancy.   

• Mixed LLD: In some cases, an individual may have both structural and functional LLD. For example, a person with a structural discrepancy may develop compensatory muscle imbalances or pelvic tilt, further exacerbating the functional impact of the discrepancy.  

Causes  

There are different factors that cause LLD which are categorized into congenital, developmental, and acquired causes.  

• Congenital Causes: This includes birth defects and genetic disorders. 

• Developmental Causes: This includes damage to the growth plates or infection in the bones or joints during the growth period. 

• Acquired Causes: This includes trauma to the limbs, diseases such as osteomyelitis or bone tumours, or previous surgeries  

Diagnosis  

Diagnosing LLD involves a comprehensive evaluation process that includes a combination of physical examination, clinical measurements, and imaging studies and often involves a multidisciplinary team, including orthopedic surgeons, physical therapists, and radiologists, to ensure all aspects of the condition are thoroughly evaluated:  

• Medical History: This included review of the patient’s birth history, growth and development history and history of growth plate injuries, past medical conditions: Infections, bone diseases, or previous surgeries, family history and symptoms experienced.  

• Physical Examination: A detailed physical examination is conducted to assess the overall posture, gait, and limb function.  

• Clinical Measurements: Measurements are taken to determine the extent of the limb length discrepancy.  

• Imaging Studies: X-ray images, MRI and CT scans are used to provide precise measurements and help identify underlying causes of LLD.  

• Bone Age Assessment: For children and adolescents, X-rays of the hand and wrist can be used to determine bone age and predict future growth potential.  

Treatment Options  

Treatment for LLD is highly individualized and involves a combination of non-surgical and surgical methods depending on the patient’s specific needs, age, skeletal maturity, and the severity of the discrepancy.   

Non-Surgical Treatments 

Non-surgical approaches are generally recommended for minor discrepancies (usually less than 2 centimeters) or for patients who may not be suitable candidates for surgery.  

• Shoe Lifts and Inserts: Shoe lifts and inserts are crucial for managing LLD is a non-invasive, cost-effective treatment that help balancing limb lengths, significantly improving gait and reducing the strain put on the hips, knees, and lower back. By providing immediate correction, shoe lifts and inserts can alleviate pain, enhance mobility, and prevent the development of further musculoskeletal issues, thereby improving the overall quality of life for individuals with LLD.  

• Physical Therapy: Physical therapy is essential for managing LLD in addressing muscular imbalances, joint stiffness, flexibility, pain and compensatory movement patterns that often accompany the condition.  It also plays a crucial role in postoperative rehabilitation for those undergoing surgical treatments, ensuring a smoother recovery process, preventing complications, and helping patients regain optimal mobility and quality of life.  

• Physical therapy is highly personalized based on the specific needs and severity of the discrepancy. Included in the program are:  

• Stretching exercises to maintain and improve flexibility, prevent muscle tightness, and ensure full range of motion in the joints. 

• Strengthening exercises to build strength in the muscles surrounding the hips, knees, and ankles, supporting the affected limb and compensating for discrepancies.  

• Gait training to correct abnormal gait patterns caused by LLD, improving walking efficiency and reducing compensatory movements.  

• Balance and coordination training to enhance proprioception, balance, and coordination, reducing the risk of falls and improving overall stability.  

• Pain management techniques to alleviate pain and discomfort associated with LLD through various modalities.  

Surgical Treatments 

Surgical interventions are considered for greater than 2 centimeters (about 0.79 in) discrepancy or when non-surgical methods are ineffective. Surgical options vary based on the extent of the discrepancy and the patient’s overall health.  

• Epiphysiodesis: This procedure is performed in growing children and adolescents and is less invasive compared to other surgical options. The goal of the procedure is to halt the growth of the longer limb by surgically closing its growth plate, allowing the shorter limb to catch up as the child grows and therefore improving overall limb function and alignment.  

• Limb Lengthening Surgery: This is a complex orthopedic procedure that involves gradually increasing the length of the shorter limb. The process begins with an osteotomy (surgically cutting the bone), followed by the application of an external or internal fixation device to stabilize the bone and facilitate lengthening. The device is adjusted overtime to slowly pull the bone segments apart, promoting new bone growth in the gap. Gradually the newly formed bone hardens and solidifies. The aim of the procedure is to achieve significant lengthening and improve overall limb function.  

• Bone Shortening (Shortening Osteotomy): This procedure equalizes limb length by shortening the longer limb to match the shorter one. This involves removing a segment of bone from the longer limb and stabilizing it with internal fixation, such as plates and screws, to ensure proper healing. The procedure is typically considered for adults or when limb lengthening is not feasible.   

• Symptomatic Treatment: This procedure focuses on addressing specific functional issues for patients and alleviating the symptoms without directly correcting the length discrepancy. This may include surgical interventions such as joint replacement, tendon transfer or other reconstructive surgeries to improve joint function and reduce joint pain or instability.   

• Postoperative rehabilitation
   

  – Early Stage: Focus on reducing swelling, pain management, and gentle range of motion exercises. 
  – Mid Stage: Gradual introduction of weight-bearing exercises, progressive strengthening, and flexibility work. 
  – Late Stage: Advanced strengthening, gait retraining, and functional exercises to prepare the patient for return to daily activities and sports.