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Limb Length Discrepancy Diagnosis and Treatment

Diagnosis. HistoryExaminationInvestigationsSpecial Investigations. Aetiology. CongenitalAcquired. Congenital. HemihypertrophyBeckwith-Wiedemann Syndrome (Wilms)VascularKlippel-Trenaunay SyndromeNeurofibromatosisPlexiform Neuofibroma. Acquired. Usually as a result of damage to the growth p

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Limb Length Discrepancy Diagnosis and Treatment

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    1. Limb Length Discrepancy Diagnosis and Treatment Peter Calder Royal National Orthopaedic Hospital The London Intensive Paediatric Course

    2. Diagnosis History Examination Investigations Special Investigations

    3. Aetiology Congenital Acquired

    4. Congenital Hemihypertrophy Beckwith-Wiedemann Syndrome (Wilms) Vascular Klippel-Trenaunay Syndrome Neurofibromatosis Plexiform Neuofibroma

    5. Acquired Usually as a result of damage to the growth plate Infection Trauma DDH/Perthes CP

    6. Treatment 1cm Do Nothing 1-2cm Shoe raise/consider epiphysiodesis 2-5cm Epiphysiodesis/Lengthening/Shortening >5cm Lengthening >20cms Prosthesis/Amputation

    7. When do I perform an epiphysiodesis? Anderson Green Charts Am J Dis Child 1948;75:279-290 JBJS 1963;45(A):1 Moseley Straight Line Graph Clin Orthop 1978;136:33-40 Menelaus JBJS 1966;48(B):336-339

    8. When do I perform an epiphysiodesis? Menelaus “Rule of thumb” Girls Stop growing at 14 (“ yrs post menarche) Boys stop growing at 16 Distal femoral physis grows 10 mm/yr Proximal tibial physis grows 6 mm/yr

    9. When do I perform an epiphysiodesis? Paley Me=LM/(LM-e/K) Me = Age at Rx L = Long leg length e = Desired Correction K = Constant (femur 0.71, tibia 0.57, both 0.67)

    10. Chronological versus Skeletal Greulich and Pyle Sauvegrain Tanner- Whitehouse

    11. Lengthening Distraction Osteogenesis Stability Monolateral Circular Osteotomy Latent Period Rate/Rhythm

    12. Summary Aetiology Diagnosis LLD prediction Treatment

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