walk in the park on a lovely spring day sounds delightful. But for
some, it's hard work. A person whose legs are unequal in length
expends a lot more energy than average just to take one step. That
usually means increased fatigue, which can put quite a damper on
or limb length discrepancy, is a condition in which there is a significant
difference in the length of a person's legs or arms. It can be the
result of a birth defect, disease, trauma to the limb, tumor or
infection in the limb. An inequality of the legs is more common
and usually more problematic than that of the arms. A limp, lower
back pain, scoliosis, degenerative arthritis and foot calluses are
all associated with the condition. It can also affect a child's
self esteem, particularly if he or she is taunted by peers.
good news is that in most cases LLD can be corrected. Sanjeev Sabharwal,
MD, FRCFC, chief of pediatric orthopedics at UMDNJ - New Jersey
Medical School, says lengthening a limb or straightening a deformed
one is a long process that requires a total commitment from the
patient, his or her family and the surgical team. But the results
are usually quite dramatic. He is one of the few physicians in the
area specializing in the repair of LLD and deformed limbs in children
and young adults.
process used is called distraction histogenesis or the Ilizarov
method, which is named for the pioneering work done in the early
'60s by the Russian physician. There are three phases to the treatment.
First, through a small incision, the bone is cut so it can be lengthened.
It is done very carefully so the periosteum, or bone covering, is
preserved, since it plays a major role in forming new bone. The
surgeon then places a device, known as an external fixator, around
the leg. It is comprised of lightweight carbon rings or a carbon
bar that is attached to the bone, through the leg, by wires and/or
screws. The wires are placed under a predetermined amount of tension.
The fixator will be used to slowly pull the bone apart.
five to 10 days after surgery, the second phase, known as distraction,
begins. Each day the patient or a family member turns a small wheel
on the fixator a total of 1 millimeter. It is usually done in four
installments, once at each meal and again at bedtime. The turn results
in a space forming between the two ends of the bone. New bone forms
within the space. Sabharwal says it takes about one month to gain
a centimeter of length.
the desired length or angle of the bone is achieved, the consolidation
phase begins. During this time, which is usually twice that of the
lengthening time, the new bone and tissue become solid. The fixator
is then removed under general anesthesia, and the patient is fitted
with a temporary cast or brace. This is to ensure that the new bone
does not get broken. Ongoing physical therapy to maintain joint
mobility is essential, as is follow-up care. Sabharwal says if a
patient is negligent about his after-care, temporary or even permanent
loss of function may result.
Once the fixator is in place, Sabharwal says, the procedure is essentially
painless. In fact, if a patient experiences pain, it may indicate
one or more of several problems: the lengthening is being done too
quickly; there is an infection around a pin; there is excessive
stretching of tendons and nerves; or the joints have become stiff.
Going to a highly trained specialist who knows the intricacies of
the procedure, however, greatly minimizes the risks.
his clinical work, Sabharwal is researching methods of improving
the procedure. He is currently looking at whether releasing some
of the tendons that go across the growth plate helps preserve natural
growth during lengthening.
limb lengthening is anything but a simple procedure, it's helping
many have a truly wonderful walk in the park.