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Year : 2021  |  Volume : 7  |  Issue : 1  |  Page : 8-12

Patient perspectives in the choice of management of leg length discrepancy

Department of Orthopedics, Nationwide Children's Hospital, Columbus, OH, USA

Correspondence Address:
Dr. Christopher A Iobst
Nationwide Children's Hospital, 700 Children's Drive, Suite T2E-A2700, Columbus, OH 43205
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jllr.jllr_18_21

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Background: The traditional limb length discrepancy management algorithm dictates that patients with less than 5 centimeters (cm) of leg length discrepancy should not be offered lengthening surgery as a treatment option. With the development of intramedullary lengthening nails, the procedure for limb lengthening has become more patient friendly and reliable. This study investigated current patient preferences for management when faced with a projected final length discrepancy of less than 5 cm. Materials and Methods: Following IRB approval, a retrospective chart review of a single surgeon's experience with patients presenting with clinical and radiological evidence of limb length discrepancy between 2017 and 2020 was performed. Patients were excluded from the study if the final discrepancy or projected discrepancy was more than 5 cm. The same management options for the LLD were presented to each patient and their family: 1) Observation, 2) Shoe lift, 3) Epiphysiodesis/Acute shortening of the longer limb, 4) Limb lengthening of the shorter limb. Results: Sixty-two (62) patients met the inclusion criteria. This was comprised of 45 skeletally immature patients and 17 skeletally mature patients. Forty-four (44) patients (71% of the entire group) preferred to have the shorter limb lengthened. This represents 27 (60%) of the skeletally immature patients and all 17 (100%) of the skeletally mature patients. No patients chose acute shortening or a shoe lift as definitive management. Conclusion: With 71% of patients opting for a lengthening procedure, this study demonstrates that patients prefer limb lengthening over limb shortening for discrepancies less than 5 cm. With improvements in the knowledge and techniques of limb lengthening as well as better patient experience particularly with the intramedullary lengthening nails, surgeons should not feel obligated to only offer lengthening to patients with LLD > 5 cm.

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