LIMB- LENGTHENING

Limb length equality in the lower limb is not simply a cosmetic issue, it also is a serious functional concern
The short leg gait is awkward, increases energy expenditure because of increased vertical rise and fall of pelvis and may result in back pain.

CAUSES OF LIMB LENGTH INEQUALITY

• Trauma
• Infection
• Asymmetrical paralytic conditions e.g. POLIO and CEREBRAL PALSY
• Tumors
• Juvenile rheumatoid arthritis
• Post fracture hypervascularity
• Idiopathic unilateral hypoplasia or hyperplasia

CLINIC ASSESSMENT

• Assessment for rotational and angular deformities
• Foot height differences
• Scoliosis
• Pelvic obliquity
• Joint mobility and function

OPERATIVE TREATMENT
Shortening Procedures Lengthening of the short limb is the optimal treatment, but technical difficulties and frequent combinations of lengthening procedures have made epiphysiodesis a more attractive option for small discrepancies in growing children. In adolescence limb shortening is safe and simple with low complication. Joint stiffness is rare Disadvantages

• Normal limb is operated
• Cosmetically displeasing
• Degree of possible shortening is limited because of the inability of muscle to adapt too shortening of more than 5cm.
• Final height is unacceptable

LIMB LENGTHENING PROCEDURES
This is theoretically the best option and our method of choice is ILizarov technique Acute long bone lengthening. Salter transiliac rarely used. Lengthening by slow distraction, the older procedures Putti’s 1921 technique. Wagner monolateral fixator DeBastiani (orthofix) ILizarov

COMPLICATIONS OF LENGTHENING BY ILIZAROV

Paley classified them into problems ,obstacles, complications

Problem-Pin tract infection which can be treated in OPD

Obstacle-Require a secondary procedure e.g. repeat corticotomy

Complication-unexpected sequel that compromises the final result

Minor complication-e.g.. residual equinus, can be treated surgically

Major complication-e.g.. permanent nerve palsy which cannot be treated Tibia lengthening with ILizarov

Typical frame for tibia lengthening (growing children ) has single ring distal to proximal tibia epiphysis, used with drop wire additional segment stabilization.

For significant amount of lengthening third ring can be placed more distally to allow greater mass of soft tissue

(a)before surgery	(b) With the fixator on	(c) limb- length equal
RADIOGRAPHS OF LIMB LENGTHENING OF OTHER PATIENT 5inch lengthening of leg.