Why May Surgical Intervention Be Required in Extremity Height Inequalities?

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Significant Limb Length Discrepancy

If the difference between the extremities exceeds a certain threshold (typically more than 2–2.5 cm), it can significantly impact the child’s daily life.

Rapidly Increasing Discrepancy

If the difference is expected to widen as the child grows (for example, if the growth plates are affected), surgical intervention may be necessary.

Pain and Postural Disorders

Limb length discrepancy can place excessive stress on the hips, knees, and spine, leading to pain, posture issues, and gait abnormalities.

The goal of surgical intervention is to address the problem as much as possible before the growth phase ends or the growth plates fully close, ensuring the child develops a healthy skeletal structure.

Surgical Methods

Epiphysiodesis (Growth Plate Suppression)

Purpose: To prevent the length discrepancy from increasing, the growth plate of the longer limb is temporarily or permanently closed.

Procedure: The growth plate of the longer extremity is surgically halted (either completely or partially). Meanwhile, the shorter extremity continues to grow, gradually reducing the difference.

Advantage: This is a minimally invasive procedure, particularly preferred when the child is still growing, to correct minor discrepancies.

Considerations: The child’s growth potential is crucial in determining the appropriateness of epiphysiodesis. This method is applied based on the child’s age and stage of bone development.

Limb Lengthening Surgery (Distraction Osteogenesis)

Purpose: Used to lengthen the shorter limb to the target length.

Procedure:

  • The bone in the shorter extremity is surgically cut (osteotomy).
  • External (e.g., Ilizarov frame) or internal (e.g., intramedullary nail) fixators are placed.
  • The bone ends are gradually separated by millimeter increments each day (distraction), allowing new bone tissue to form.

Process: This method can achieve greater length correction. However, the treatment duration can take months, depending on the child’s lengthening needs and healing speed.

Advantage: Effective in correcting significant discrepancies.

Disadvantage: The child’s mobility may be restricted during the lengthening process. There is also an increased risk of infection (especially with external fixators) and a high demand for daily care.

Deformity Correction Surgery

Purpose: If the limb length discrepancy is accompanied by an existing curvature (deformity) or angular misalignment, this method can correct both bone alignment and length.

Procedure:

  • The affected bone is cut at the problematic area.
  • It is aligned correctly and stabilized using plates, screws, or nails.
  • If necessary, lengthening or shortening procedures can be added.

Advantage: Since both length and alignment can be corrected in the same operation, the child’s overall gait and posture improve.

Post-Surgical Recovery: Rehabilitation and Care

Physical Therapy and Exercise

Physical therapy plays a crucial role in the recovery process. Regular exercises should be performed to prevent muscle weakness, maintain joint mobility, and ensure proper gait balance.

Fixator and Wound Care

If an external fixator is used, proper cleaning and care of the pin entry sites reduce the risk of infection. The recommended cleaning protocols should be followed meticulously.

Regular Doctor Check-Ups

Imaging techniques such as X-rays are used to monitor bone growth rate and alignment at regular intervals.