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Leg lengthening and shortening

Definition

Leg lengthening and shortening are types of surgery to treat some children who have legs of unequal lengths.

These procedures may:

Alternative Names

Epiphysiodesis; Epiphyseal arrest; Correction of unequal bone length; Bone lengthening; Bone shortening; Femoral lengthening; Femoral shortening

Description

BONE LENGTHENING

This series of treatments involves several surgeries, a long recovery period, and a number of risks. However, it can add up to 6 inches of length to a leg.

The child will be under general anesthesia. This means the child is asleep and pain-free during surgery.

When the leg has reached the desired length and has healed, another surgery is done to remove the pins.

BONE RESECTION OR REMOVAL

This is a complicated surgery that can produce a very precise degree of correction.

While the child is under general anesthesia:

BONE GROWTH RESTRICTION

Bone growth takes place at the growth plates (physes) at each end of long bones.

The child is under general anesthesia. The surgeon makes a cut over the growth plate at the end of the bone in the longer leg.

REMOVAL OF IMPLANTED METAL DEVICES

Metal pins, screws, staples, or plates may be used to hold the bone in place during healing. Most orthopedic surgeons prefer to wait several months to a year before removing any large metal implants. Removal of implanted devices requires another surgery using general anesthesia.

Why the Procedure Is Performed

Leg lengthening is considered if  person has large differences in leg length (more than 5 cm or 2 inches). Leg lengthening is more likely to be recommended:

Leg shortening or restricting is considered for smaller differences in leg length (usually less than 5 cm or 2 inches). Shortening a longer leg may be recommended for children whose bones are no longer growing.

Bone growth restriction is recommended for children whose bones are still growing. It is used to restrict the growth of a longer bone, while the shorter bone continues to grow to match its length. Proper timing of this treatment is important to ensure good results.

Certain health conditions can lead to severely unequal leg lengths. They include:

Risks

Risks for any anesthesia include:

Risks for any surgery include:

Additional risks include:

After the Procedure

After bone growth restriction:

After bone shortening:

After bone lengthening:

Because the blood vessels, muscles, and skin are involved, careful and frequent checking of the skin color, temperature, and sensation of the foot and toes is important. This will help identify any damage to blood vessels, muscles, or nerves as early as possible.

Outlook (Prognosis)

Bone growth restriction (epiphysiodesis) is usually successful when it is done at the correct time in the growth period. However, it may cause short stature.

Bone shortening may be more exact than bone restriction, but it requires a much longer recovery period.

Bone lengthening is completely successful about 40% of the time. It has a much higher rate of complications.

References

Beaty H. Congenital anomalies of the lower extremity. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier;2007:chap 26.

Friedman JE, Davidson RS. Leg-length discrepancy. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 668.


Review Date: 11/12/2012
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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