Orthopedics

Leg length discrepancies and bone and joint deformities can have a number of causes and in more severe cases, lead to a number of life-long issues. That’s why the Pediatric Orthopedics team at Tufts Medical Center in Boston offers a Limb Lengthening and Reconstruction Program. Our orthopedic surgeons offer a wide range of individualized treatment options in a caring and family-friendly environment.

Bone and joint deformities

Bone and joint deformities can be congenital, developmental or caused by an infection or trauma. These deformities can lead to crooked bones or joints which can cause gait disturbance, mechanical axis deviation and premature arthritis as well as cosmetic and social issues.

Types of Bone and Joint Deformities

The most common bone and joint deformities that Tufts Medical Center’s pediatric orthopedic surgeons treat include:

• General bone deformities – bow legs, knock knee, tibia vara, post fracture or infection deformities
• Limb length discrepancies
• Congenital lower limb deficiencies – congenital short femur, proximal femoral focal deficiency, fibular hemimelia, tibial hemimelia
• Foot deformities
• Osteomyelitis (bone infection)
• Nonunion of fractures including congenital pseudarthrosis of the tibia
• Bone defects following trauma, infection or tumor excision
• Short residual limb following amputation
• Joint contractures including pterygium

Treating Bone and Joint Deformities

In order to treat your or your child’s bone or joint deformity, we evaluate the symptoms and natural history of the deformity and use computer models to measure its magnitude. If the deformity needs to be corrected, our surgeons will identify the apex or apices of the deformed bone and cut the bone at the apex to straighten it. Based on your condition, we may recommend one of the following deformity correction techniques:

• Growth guided surgery – This technique is available only for children and allows for a gradual correction and rapid return to activities. A small plate and screws are placed close to the growth plate to modulate growth and correct the bone deformity slowly while the child grows.
• Osteotomy and acute correction – The deformed bone is cut and immediately held in a corrected position with plates and screws or a rod.
• Osteotomy and gradual correction – This is a highly technical procedure that involves computer generated modules to guide treatment. The deformed bone is cut and the ends of the bone are gradually moved apart to the corrected position and held by an external fixator.

Leg length discrepancies (LLD)

Leg length discrepancy is the difference between the length of one leg compared to the other. Small discrepancies are very common and often go untreated. However, larger discrepancies can cause inefficient gait, chronic pain, back pain and degenerative joint changes.

Treating leg length discrepancies

If you or your child has a noticeable leg discrepancy, you should call our pediatric orthopedic surgery team for a consultation. During this consultation, we will determine whether action is necessary and if so, begin formulating a treatment plan.

Adults’ leg length discrepancy can be measured but because children are still growing, our experts evaluate our pediatric patients’ projected limb length difference at the completion of growth (adulthood). Based on this measurement, the following treatment is recommended:

• 0-2cms: No treatment necessary
• 2-5cms: Shoe lift and limb shortening of long leg
• 5-20cms: Limb lengthening (may be combined with other treatments)
• 20cms or more: Limb lengthening or prosthetics

Limb lengthening can sound like a scary procedure, but our surgeons have strong experience in using both the external fixator and lengthening over intramedullary nail methods. During both methods, our surgeons cut a short bone into two segments and gradually move the cut ends of the bone apart, allowing new bone to form in the gap.