True Leg Length Discrepancy

Aka: True Leg Length Discrepancy, Leg Length Discrepancy, Leg-Length Discrepancy, Limb Length Discrepancy, Leg Length Inequality

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II. Causes

  1. Idiopathic unilateral hyperplasia or hypoplasia
  2. Growth Plate injury
    1. Trauma
    2. Infection
  3. Asymmetric paralysis
    1. Poliomyelitis
    2. Cerebral Palsy
  4. Mass induced growth
    1. Tumor
    2. Juvenile Rheumatoid Arthritis
    3. Post-Fracture hypervascularity

III. Exam: Fixed point to fixed point testing

  1. Position
    1. Patient lies supine with legs in neutral position
  2. Measurement (compare both sides)
    1. Anterior superior iliac spine to medial malleolus
  3. Interpretation
    1. Leg Length Discrepancy if difference between sides

IV. Exam: Evaluate tibia and femur lengths

  1. Position
    1. Patient lies supine
    2. Knees flexed at 90 degrees and feet flat on table
  2. Interpretation
    1. One knee higher than other: Tibia longer
    2. One knee projects further anteriorly: femur longer

V. Management: True Limb Length Discrepancy >1.5 cm

  1. Shoe lift or prosthetic conversion
  2. Surgical intervention
    1. Epiphysiodesis of long leg
    2. Long leg shortening or short leg lengthening

VI. Complications

  1. Compensatory Scoliosis
  2. Low Back Pain
  3. Gait abnormalities with secondary injuries

VII. References

  1. Canale (1998) Campbell's Orthopaedics, Mosby, p. 986
  2. Hoppenfeld (1976) Spine and Extremities, p. 165

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