25. Limb Equalisation

From greek.doctor
  • Limb equalisation surgery, also called limb lengthening surgery, is performed when correction with shoes is inadequate, often at > 2,5 cm discrepancy
  • Multiple surgical procedures are available to correct limb length
    • Some are complex, but by combining two or more of them we can reduce the complexity and the number of operations required
  • Temporary epiphysiodesis – using screws or staples across the epiphyseal plate
    • Can only be used in skeletally immature patients, of course
    • This prevents further growth of the longer limb until the short limb has “caught up”
  • Permanent epiphysiodesis – the surgical destruction of the epiphyseal plate
    • Can only be used in skeletally immature patients, of course
    • The epiphysis of the longer limb is removed (then turned 90° and re-inserted)
    • If timed correctly, the shorter limb will continue to grow but stop growing when it reaches the length of the operated limb
  • Limb shortening
    • By osteotomy
    • Is less complex and has faster healing period than limb lengthening
    • Femoral osteotomy is preferred over tibial osteotomy
    • The ends are fixated together
  • Limb lengthening by callotasis (= distraction osteogenesis)
    • First, a part of the bone is removed by osteotomy
    • A distracting device is used to distract the area of the bony callus
      • The distracting device may be external or internal
      • Internal rods are often used
    • The distraction is adjusted multiple times daily and for very small lengths each time
      • New bone will fill the gap
    • After the target length has been reached, the patient must gradually put more and more weight on the bone to strengthen the new bone
  • Monitoring and post-operative
    • During distraction, x-ray is routinely taken to monitor
    • 3 – 4 weeks after distraction is complete the distraction device is left in place to provide stabilization
    • Weight-bearing is recommended to mature the bone
  • Complications
    • Infections
    • Angular deformities like varus or valgus due to non-axial weight-bearing
    • Joint contractures due to muscle imbalances