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rosannaarboleda

Functional Leg Length Discrepancy Stretches

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Surgical lengthening of the shorter extremity (upper or lower) is another treatment option. The bone is lengthened by surgically applying an external fixator to the extremity in the operating room. The external fixator, a scaffold-like frame, is connected to the bone with wires, pins or both. A small crack is made in the bone and tension is created by the frame when it is "distracted" by the patient or family member who turns an affixed dial several times daily. The lengthening process begins approximately five to ten days after surgery. The bone may lengthen one millimeter per day, or approximately one inch per month. Lengthening may be slower in adults overall and in a bone that has been previously injured or undergone prior surgery. Bones in patients with potential blood vessel abnormalities (i.e., cigarette smokers) may also lengthen more slowly. The external fixator is worn until the bone is strong enough to support the patient safely, approximately three months per inch of lengthening. This may vary, however, due to factors such as age, health, smoking, participation in rehabilitation, etc. Risks of this procedure include infection at the site of wires and pins, stiffness of the adjacent joints and slight over or under correction of the bone?s length. Lengthening requires regular follow up visits to the physician?s office, meticulous hygiene of the pins and wires, diligent adjustment of the frame several times daily and rehabilitation as prescribed by your physician.Leg Length Discrepancy

Causes

The causes of LLD are many, including a previous injury, bone infection, bone diseases (dysplasias), inflammation (arthritis) and neurologic conditions. Previously broken bones may cause LLD by healing in a shortened position, especially if the bone was broken in many pieces (comminuted) or if skin and muscle tissue around the bone were severely injured and exposed (open fracture). Broken bones in children sometimes grow faster for several years after healing, causing the injured bone to become longer. Also, a break in a child?s bone through a growth center (located near the ends of the bone) may cause slower growth, resulting in a shorter extremity. Bone infections that occur in children while they are growing may cause a significant LLD, especially during infancy. Bone diseases may cause LLD, as well; examples are neurofibromatosis, multiple hereditary exostoses and Ollier disease. Inflammation of joints during growth may cause unequal extremity length. One example is juvenile rheumatoid arthritis. Osteoarthritis, the joint degeneration that occurs in adults, very rarely causes a significant LLD.

Symptoms

Children whose limbs vary in length often experience difficulty using their arms or legs. They might have difficulty walking or using both arms to engage in everyday activities.

Diagnosis

A qualified musculoskeletal expert will first take a medical history and conduct a physical exam. Other tests may include X-rays, MRI, or CT scan to diagnose the root cause.

Non Surgical Treatment

After the leg length discrepancy has been identified it can be categorized in as structural or functional and appropriate remedial action can be instigated. This may involve heel lifters or orthotics being used to level up the difference. The treatment of LLD depends on the symptoms being experienced. Where the body is naturally compensating for the LLD (and the patient is in no discomfort), further rectifying action may cause adverse effects to the biomechanical mechanism of the body causing further injury. In cases of functional asymmetry regular orthotics can be used to correct the geometry of the foot and ground contact. In structural asymmetry cases heel lifts may be used to compensate for the anatomic discrepancy.

LLD Shoe Inserts

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Surgical Treatment

Shortening techniques can be used after skeletal maturity to achieve leg length equality. Shortening can be done in the proximal femur using a blade plate or hip screw, in the mid-diaphysis of the femur using a closed intramedullary (IM) technique, or in the tibia. Shortening is an accurate technique and involves a much shorter convalescence than lengthening techniques. Quadriceps weakness may occur with femoral shortenings, especially if a mid-diaphyseal shortening of greater than 10% is done. If the femoral shortening is done proximally, no significant weakness should result. Tibial shortening can be done, but there may be a residual bulkiness to the leg, and risks of nonunion and compartment syndrome are higher. If a tibial shortening is done, shortening over an IM nail and prophylactic compartment release are recommended. We limit the use of shortenings to 4 to 5 cm leg length inequality in patients who are skeletally mature.

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