Acquired Leg Length Discrepancy

Intro

Treatment Options

Complications

Orthofix Solutions

Acquired Leg Length Discrepancy

Post-traumatic leg length discrepancies (LLD) are more common in adults, mostly caused by accidents and tumors: 1-3

  • Fractures: unlike in developmental causes, there is no risk of affecting the growth plates, since these are already closed and the bone is fully grown. However, severe fractures with loss of bone can cause bone (and consequently leg) shortening.
  • Bone healing problems: LLD can develop if the bone heals in a wrong or shortened position (malunion). In some cases, the patients cannot produce enough bone tissue to repair a fracture, and the bone does not heal at all (nonunion). This may be because the bone does not receive enough blood flow or because the fracture place is not stable enough.
  • Tumors: in adults, bone tumors can affect leg length because the tumor takes the place of healthy tissue as it grows. This can cause pain, bowing of the bone, fractures, and LLD.

These acquired causes of LLD affect the patients’ gait, muscles, and joints. 1

Fitbone™

Important safety information: Download the Product Instructions For Use.

The FitboneTM Intramedullary Limb-Lengthening System was developed in partnership with Professor Baumgart.  The product was launched in 1997.  Since then, this innovative treatment concept has grown into a global success story. The Fitbone TAA Intramedullary Lengthening system is intended for limb lengthening of the femur and tibia. With appropriate pre-operative planning, it is possible to ensure good limb alignment so that the limb is correct at the end of lengthening.

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Treatment Options

Treating an acquired LLD is necessary when there is a discrepancy larger than 2cm between legs. The objectives are to improve function and improve the patient’s quality of life, by promoting a balanced gait that does not put extra pressure on joints and muscles. 1-3

External fixators can be used to secure the bone after an osteotomy (surgical cutting or removal of a bone segment), allowing for new bone to grow in the gap between the two bone endings. 3

An alternative to external fixators are the newer motorized intramedullary (IM) lengthening nails. IM nails have the advantage of avoiding some complications usually associated with external fixators, such as pin site infections, and have the potential to provide a faster treatment and better cosmetic results. 4-5

For each LLD case, there has to be careful planning and discussion of treatment options with the patient. The decisions regarding treatment have to account for the surgeon’s experience, the cause that led to the traumatic LLD, the patient’s support system and their expectations, to maximize the chances of success. 1

Complications

Patients with a low-degree LLD may not have an impact on their activities of daily living or their health. However, as the LLD becomes more pronounced, the patient’s life will be impacted by the persistent limp that puts pressure on joints and muscles. If left untreated, even a mild LLD can cause permanent hip and back problems.6, 7

In severe cases, the impact on the patient’s health is more apparent, and delaying treatment will result in secondary problems, including arthritis and degenerative spine disease. 7

  1. Butcher CC, Atkins RM. (Ii) Principles of deformity correction. Current Orthopaedics. 2003;17(6):418-435. doi:10.1016/j.cuor.2003.10.001
  2. Ralston SH, Langston AL, Reid IR. Pathogenesis and management of Paget’s disease of bone. The Lancet. 2008;372(9633):155-163. doi:10.1016/S0140-6736(08)61035-1
  3. Jones MS, Waterson B. Principles of management of long bone fractures and fracture healing. Surgery (Oxford). 2020;38(2):91-99. doi:10.1016/j.mpsur.2019.12.010
  4. Chimutengwende-Gordon M, Mbogo A, Khan W, Wilkes R. Limb reconstruction after traumatic bone loss. Injury. 2017;48(2):206-213. doi:10.1016/j.injury.2013.11.022
  5. Krieg AH, Lenze U, Speth BM, Hasler CC. Intramedullary leg lengthening with a motorized nail: Indications, challenges, and outcome in 32 patients. Acta Orthopaedica. 2011;82(3):344-350. doi:10.3109/17453674.2011.584209
  6. Gordon, J. E., & Davis, L. E. (2019). Leg Length Discrepancy: The Natural History (And What Do We Really Know). Journal of pediatric orthopedics, 39(Issue 6, Supplement 1 Suppl 1), S10–S13.
  7. Applebaum A, Nessim A, Cho W. Overview and Spinal Implications of Leg Length Discrepancy: Narrative Review. Clin Orthop Surg. 2021;13(2):127-134. doi:10.4055/cios20224