- 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