Limb length discrepancy (LLD) describes a pediatric health condition in which legs or arms of a child vary in length. Generally, minor difference between lengths of legs does not create any significant problem. However, if the difference is more, children may not be able to walk properly which can adversely impact their quality of life. Unlike leg discrepancy, difference in length of arms does not cause any functional disability and doesn't need any dedicated treatment. Parents should consult an experienced pediatric orthopedic surgeon if they notice any type of abnormality in child's leg. Early treatment will raise the chances of positive outcomes.
Causes of Limb Length Discrepancy (LLD)
The following points give out the most common causes that lead to limb length discrepancy.
- Hereditary - Limb length discrepancy may be present by birth in a child. Such condition is referred to as congenital limb length discrepancy.
- Bone Infection and Diseases - Any type of infection in bones is the most common cause of LLD. Diseases such as juvenile arthritis, neurofibromatosis, polio, cerebral palsy, and Ollier's disease are the major health issues which are known to fuel up probability of limb length discrepancy in a child.
- Injury or Fracture - A serious fracture or injury can affect normal growth of limbs. Eventually, it may create a noticeable variation in limbs. Parents must pay attention and talk to a doctor to minimize such risks.
Signs and Symptoms of Limb Length Discrepancy
The below list elaborates some dominant signs and symptoms of limb length discrepancy.
- Walking Pattern - When difference between legs of a child is nearly 3 cm or beyond, then it hampers their normal walking pattern.
- Dullness and Weakness - Child may get tired easily after playing or performing activities like running. This is because the child needs extra energy to cope up with the variation in leg. In some instances, children may experience low back pain after a strenuous physical activity.
- Standing Posture - LLD can be identified by analyzing a child's standing posture. Child may not be able to stand straight. They may trip and lose balance often while standing.
Parents should keep an eye on children and meet a doctor without hesitation for medical help.
Diagnosing Limb Length Discrepancy
Parents must search out a well-trained orthopedic surgeon who specializes in treating problems like LLD in children. It will ensure good outcomes and help in normal physical development of child following treatment.
- Physical Evaluation - Respective pediatric orthopedic surgeons are most likely to begin the diagnosis procedure by an intensive physical examination. They will check medical history of child and look out for signs of LLD. After that, they will carefully observe the standing, walking, and sitting posture of child. They may take help of wooden boxes and ask child to stand still. It will help them to measure the exact gap or difference between both the legs.
- Imaging Tests - Once physical examination is over, respective doctors may refer children to good medical radiologists for conducting certain essential imaging tests like CT scan, x-ray or scanogram x-ray imaging. These painless tests are capable of giving out internal details such as position of leg and nearby structures. Child will just need to lie straight in front of scanning device as per doctor's instruction.
Surgeons will analyze the report and decide a suitable solution to treat limb length discrepancy of child.
Treatment Options for Limb Length Discrepancy
Treatment for limb length discrepancy will vary depending on severity of condition. For instance, treatment for mild limb length discrepancy will be different from treatment that is generally given for serious cases.
- 1. Mild Limb Length Discrepancy Treatment - Generally, mild LLD do not require any aggressive treatment or surgery. The following measures can help resolve the problem of mild leg length discrepancy.
- Monitoring - Children are monitored from time to time to check status of limbs. Doctors may suggest an operation if discrepancy increases after a certain time span.
- Shoe Lift - For LLD less than 2 cm, surgeons may suggest children wear a shoe with a lift. It can minimize back pain and help children walk smoothly.
- 2. Severe Limb Length Discrepancy Treatment - A limb length correction surgery is the best alternative to treat severe cases. Surgery focuses on achieving one of these objectives - control growth of longer limb, reduce the size of longer limb or increase length of shorter limb. The following procedures can fulfill this purpose with a high level of accuracy.
- Growth Modulation Surgery - During this surgery, growth plate of upper thigh bone or lower leg bone is temporarily locked with the help of metal plates and screws. It can be relieved once growing phase of child gets over or is about to get completed. It is a good option to correct discrepancy that is equal to or less than 3 cm.
- Limb Lengthening Surgery - Limb lengthening procedure is subdivided into two groups namely - external lengthening and internal lengthening. External lengthening involves cutting the specific bone in two parts and implanting an external fixator in proper position by means of pins and wires. This method accelerates growth of new bone in space between parted bones. In case of internal lengthening, bone is cut and a metal rod is implanted to help it increase in length.
- Limb Shortening Surgery - Limb shortening is performed when a child has surpassed growing phase. Respective doctors cut down a small portion of affected leg bone and insert rods or metal plates until it heals entirely.
Risks and Complications Associated with Limb Length Discrepancy Surgery
The following list conveys major risks and complications associated with surgical procedures for limb length discrepancy.
- Stiffness - Children may encounter stiffness or swelling in the operated leg.
- Infection - Use of metal rods, pins, or external fixators may cause infection.
- Disproportionate Limbs - There may arise a situation leading to either over correction or under correction of limbs.
- Severe Pain - Children may have to face uneasiness and pain in initial days of the healing period.
All these complications can be managed effectively by taking proper measures and follow-up care.
Recovery Following Surgery for Limb Length Discrepancy
Recovery time will vary according to type of LLD procedure and child's general health condition. During the recovery time, children must avoid participating in high-impact sports and activities. They should eat well and take medicines as prescribed by surgeons. In addition to this, parents must take them for follow-up care sessions without fail. On an average, it will take nearly 3 to 4 months to recover fully.
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