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Leg Length Differences and Limb Deformity
Limb Lengthening, Shortening, and StraighteningMany children have limbs that need to be lengthened, shortened, or straightened, to maximize their function and abilities. At Rady Children’s Hospital we have a team of specialists dedicated to helping families and patients understand the surgical and non-surgical options for correcting extremities that are too long, too short, malrotated or misaligned. Limb deformity and leg length difference can be present from birth (congenital) or acquired from trauma, tumors, infections or metabolic problems. There are many conditions that correct as a child grows (See handouts on in-toeing, out-toeing, bowlegs, knock knees, and flat feet). Our experts will be able to tell you if the condition is likely to correct with time or if bracing or surgical correction is recommended. There are many ways to correct an extremity that is not developing normally:
 Growth Modulation:In a growing child, the direction of growth can be changed with surgical manipulation of the growth plate to make a crooked bone grow straight. The growth plates can be temporarily redirected with plates, screws, or staples. Growth plates can also be permanently closed to slow the growth and thus shorten a long extremity in relation to the other. This type of correction takes time and can only be done in a growing child as growth is the determining factor that allows the bone to straighten. The scars from these procedures are very small and the recovery time is minimal. Patients are usually back to running and sports 2 weeks following surgery. When the extremity is straight, the device can be removed and growth resumes in a normal fashion.
For more information on bone healing see: www.bonehealingeducation.com
There have been great advances in the technology and design of external fixators. We can now correct deformities in multiple planes (length, rotation and deformity) with a single external fixator The Taylor Spatial Frame is often used for these very complex corrections. (For information on the Taylor Spatial Frame, see www.jcharlestaylor.com/tsfliterature/01TSF-mainHO.pdf ). Computers are used to calculate exactly how to correct each unique problem to get the best outcome for your child. If you and your doctor decide that an external fixator is the best option for your child, you need to understand that this is a lengthy process that will require the support of the whole family as well as the medical team. You and your child will need to be very involved in this process. The external fixator needs to be adjusted 3-4 times per day to allow a very gradual correction. You cannot take a day off or speed up the process. You will need to clean the pin sites daily, attend physical therapy at least twice a week, and initially come in for weekly doctor appointments. Please see: What to expect before, during, and after your treatment with an external fixator …and what you can do to ensure the best result for more information. The end result can be a significant improvement, but it will require dedication and hard work for the patient and his or her family.
Of note, we do not do cosmetic lengthening procedures at Rady Children’s Hospital, only those that are medically necessary to correct leg length difference or deformity. Mentoring and support groups are an important component of our program. If you would like to meet another child or adult who has experienced and overcome some of the issues you are experiencing, or if you would like to participate in our mentor program, please call Dr. Pring at 858-966-6789 extension 7928.
Additional information can be found by clicking the following links:
A Division of Children's Specialists 3030 Children’s Way, Suite 410 San Diego, CA 92123 (858) 966-6789
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CSSD Division of Orthopedics