When people hear of orthopedic care, they immediately assume this is meant for adults and the aged. The age-old belief that orthopedic care is only intended for arthritis and fractures has informed this misconception.
Fractures might not be as common in kids since their bones “bounce” when hit and arthritis is commonly associated with advancing age. Pediatric orthopedic care is, nonetheless now a mainstream specialty in medical care with the realization that several bone issues affect kids.
One common issue handled by a general physician doctor based here in Des Moines, IA is a limb length discrepancy. This is generally associated with congenital disabilities and trauma. Some of the common congenital disabilities that will contribute to a limb length discrepancy are congenital tibial bowing or short femur, fibular hemimelia, Russell Silver syndrome and hemihypertrophy or hemiatrophy.
Shoe inserts are the common conservative treatment alternatives for a limb discrepancy since this allows some lengthening of the shorter limb. The definitive treatment, in most cases, is nonetheless a surgical procedure. Here are the surgical procedures that can be used for pediatric limb lengthening.
Gradual Lengthening and Correcting Deformity
This procedure encompasses the mounting of an external fixator on the shorter limb. The external fixators used in this case include straight bars along a side of the leg or circular rings that surround the limb. The surgeon will gently divide the short bone into two when the fixator is in place.
As new bone grows and with the fixator’s adjustment, the gap will be filled by new bone that lengthens the limb.
Bones have a special cartilage layer at their ends called growth plates that allow bone growth. When children reach maturity, the growth plate cartilage will become bones and bone growth is no longer possible. Epiphysiodesis is designed to slow the growth of bones.
It involves the surgical drilling into the bone and removal of the growth bone cartilage of the longer limb. In so doing, growth of the longer limb stops and the shorter one can catch up. Epiphysiodesis is done in kids between 10-14 years with length differences of not more than 5cm.
This procedure allows crooked bones to straighten and consequently lengthen the limb. A small metal plate will be attached to one end of the growth plate on the bent bone. It slows the growth of this side of bone while the other keeps growing and straightens the limb.
Hemiepiphysiodesis is done in kids whose limbs are still growing and takes 6-12 months to straighten the bone.
This is used to correct limb lengthening discrepancies of 2-5cm. A piece of bone will, in this instance, be removed from the longer limb before the shortened bones are fixed using a metal rod or plate. Limb shortening is used for kids whose bones have stopped growing or are near the end of their bone growing phase.
The recovery time from the above procedures differs based on the specifics of your child’s surgery. Once healed, your child will need physiotherapy to regain the functioning of the operated limb. In a few cases, you might need a second procedure to remove the devices placed in the limb during surgery.