Leg lengthening and shortening

Alternative Names: Epiphysiodesis; Epiphyseal arrest; Correction of unequal bone length; Bone lengthening; Bone shortening; Femoral lengthening; Femoral shortening

Leg lengthening and shortening are types of surgery to treat some children who have legs of unequal lengths.

These procedures may:

• Lengthen an abnormally short leg
• Shorten an abnormally long leg
• Limit growth of a normal leg to allow a short leg to grow to a matching length

Description of Procedure

BONE LENGTHENING

This series of treatments involves several surgical procedures, a long recovery period, and a number of risks -- but it can add up to 6 inches of length to a leg.

While the child is under general anesthesia:

• The bone to be lengthened is cut.
• Metal pins or screws are inserted through the skin and into the bone. Pins are placed above and below the cut in the bone, and the surgical cut in the skin is stitched closed.
• A metal device (usually some sort of external frame) is attached to the pins in the bone. It will be used later to very slowly (over months) pull the cut bone apart. This creates a space between the ends of the cut bone that will fill in with new bone.

Later, when the leg has reached the desired length and has healed (usually after several months), another surgical procedure will be done to remove the pins.

BONE RESECTION OR REMOVAL

This is a complicated surgery that can produce a very precise degree of correction.

While the child is under general anesthesia:

• The bone to be shortened is cut and a section of bone is removed.
• The ends of the cut bone will be joined and a metal plate with screws or a nail down the center of the bone is placed across the bone incision to hold it in place during healing.

BONE GROWTH RESTRICTION

Bone growth takes place at the growth plates (physes) at each end of long bones.

While the child is under general anesthesia, the surgeons make a surgical cut over the growth plate at the end of the bone in the longer leg.

• The growth plate may be destroyed by scraping or drilling it (epiphysiodesis or physeal arrest) to stop further growth at that growth plate.
• Another method is to insert staples on each side of the bony growth plate. These can be removed when both legs are close to the same length.

REMOVAL OF IMPLANTED METAL DEVICES

Metal pins, screws, staples, or plates may be used to stabilize bone during healing. Most orthopedic surgeons prefer to wait several months to a year before removing any large metal implants. Removal of implanted devices requires another surgical procedure using general anesthesia.

Risks of Leg lengthening and shortening

Risks for any anesthesia include:

• Reactions to medications
• Problems breathing

Risks for any surgery include:

• Bleeding
• Infection

Additional risks include:

• Bone growth restriction (epiphysiodesis), which may cause short height
• Bone infection (osteomyelitis)
• Injury to blood vessels
• Poor bone healing
• Nerve damage

Leg lengthening - series

Review Date: 11/12/2010
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

_{Do not use this information for medical emergencies - Call 911. This information should not be used for the diagnosis or treatment of any medical condition. A licensed medical practitioner should always be consulted for diagnosis and treatment of any and all medical conditions. Links to other websites do not constitute endorsements and are provided for information only. Any duplication or distribution of this information is strictly prohibited.
Copyright 2011 A.D.A.M., Inc.}