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Length Discrepancy
By
Dr Frazand Ali
PG-Trainee Orthopedics
LGH Lahore
Limb Length Discrepancy
Difference between the
length of upper and
lower arm / upper and
lower leg is called “Limb
Length Discrepancy”
(LLD)
Causes
Congenital : Infections
Femoral deficiency Poliomyelitis
Coxa vara Septic arthritis
Fibular hemimelia Osteomylitis leading
Tibial hemimelia to growth plate
Psuedarthrosis of tibia damage
Neurofibromatosis Neurological
Cerebral palsy
Trauma
Over riding fracture Tumour
Multiple exostosis
Epiphyseal injuries
leading to shortening Inflamatory
Rheumatoid arthritis
Signs and Symptoms
Limping gait
Unappealing shoe lift
Low back ache
Compensatory scoliosis
Degenerative arthrosis of lumbar and
sacral region
Compensation and
Tolerance
Different Patients respond differently
to LLD depending upon age, height
and body weight e.t.c.
children tolerate discrepancies better
than adults because of their inherent
flexibility
a 6-foot-tall patient tolerates a 2-cm
discrepancy with little or no trouble,
whereas a 5-foot-tall patient would
be less tolerant of the same
discrepancy.
Clinical Examination
Limb shortening
The relative knee heights are measured
with the hips and knees flexed.
congenital longitudinal
deficiency of the tibia,
congenital dysplasia of the tibia,
paraxial tibial hemimelia, tibial
dysplasia, and congenital
deficiency or absence of the
tibia.
Causes
Exact cause is unknown,
Sweet and Lane described a
murine model for tibial hemimelia in
which the dominant mutation resides
on the X chromosome.
Classification
Jones, Barnes, and Lloyd-Roberts
classification which is based on
the early roentgenographic
presentation;
Cause ------------unknown
Presenting Complaints
leg-length discrepancy with
equinovalgus deformity of the foot
flexion contracture of the knee
femoral shortening
instability of the knee and ankle
a stiff hindfoot with absent lateral
rays
Classification
– Class A there is a
normal acetabulum
and femoral head
with shortening of
the femur and
absence of the
femoral neck on
early
Class B there is no
bony connection
between the
proximal femur
and the femoral
head, and a
pseudarthrosis is
present
Class C there is
further degradation
in the formation of
the hip,
characterized by a
dysplastic
acetabulum,
absent femoral
head, and short
femur
Class D the
acetabulum,
femoral head, and
proximal femur are
totally absent
unlike in class C,
there is no ossified
tuft capping the
proximal femur.
.
Kalamchi et al developed a simplified
classification scheme for congenital
deficiency of the femur that included five
groups:
group I, short femur and intact hip joint;
group II, short femur and coxa vara of the
hip
group III, short femur but well-developed
acetabulum and femoral head;
group IV, absent hip joint and dysplastic
femoral segment
group V, total absence of the femur.
Nine Pappas Classification of
Congenital Abnormalities of the
Femur
Class I Femur absent
Ischiopubic bone structures
Underdeveloped and
deficient Lack of Acetabular
development
Class II(Aitken D) Femoral
head absent Ischiopubic
bone structures delayed in
ossification
Class III(Aitken B) No
osseous connection between
femoral shaft and head
Femoral head ossification
Class IV(Aitken A) Femoral
head and shaft joined by
irregular calcification in
Fibrocartilaginous matrix