Limb Length Discrepancy (LLD) - negative ulna

[Guest guest]

Dear Marilette!

 

Namaste.

 

A 15-year old (doctor says growth has finished)girl as

problems with her arm: the ulna is 4mm too short, now

they want to shorten the radius.

 

Is there a way to avoid the operation?

Could you pls. give me medical background and

protocol?

 

Thank you!

Alex

 

 

=============================

 

 

Dear Alex,

 

Namaste.

 

Thank you for your email.

 

Kindly provide more information regarding the

difficulties being experienced by this patient for

proper treatment.

 

Medical Background:

 

Pediatric forearm deformities may result from

congenital, developmental, and posttraumatic

conditions. When analyzing the potential for

correcting a forearm deformity, its cause and its

changing nature during growth must be considered.

Length corrections of the upper extremity are

indicated in fewer instances than in the lower

extremity because moderate discrepancies in forearm

length usually do not produce significant functional

or cosmetic problems.

 

Large length discrepancies and severe angular or

articular deformities do result in functional and

cosmetic problems. Small variations in length between

the radius and ulna (i.e., multiple hereditary

exostoses) or an absence of either bone (i.e., radial

aplasia), also can result in disturbed function and

cosmesis.

 

Ulna variance is considered negative when it is the

ulna that is short.

 

Limb Length Discrepancy (LLD) may be due to normal

variation that occurs between the two sides of the

body. Or it may be due to other causes.

 

There are many possible causes of LLD:

 

-Previous injury: A previously broken bone may cause

LLD if it healed in a shortened position. This can

happen if the bone was broken in many pieces

(comminuted) or if the skin and muscle tissue around

the bone were severely injured and the bone was

exposed (open fracture). In children, broken bones may

grow faster for several years after healing. This

causes the injured bone to become longer. A break in a

child's bone through the growth center (located near

the ends of the bone) can cause slower growth. This

results in a shorter extremity.

 

-Bone infection: Bone infections in growing children,

especially infants, may cause significant LLD.

 

-Bone diseases (dysplasias): These include

neurofibromatosis, multiple hereditary exostoses and

Ollier disease.

 

-Inflammation: Juvenile rheumatoid arthritis is one

example of inflammation of joints during growth that

can cause unequal extremity length. Joint degeneration

in adults (osteoarthritis) rarely causes significant

LLD.

 

-Neurological conditions: Neurological conditions

during childhood, such as cerebral palsy, polio and

obstetrical brachial plexus palsy, may affect the

growth of an arm or leg and result in LLD.

 

Sometimes conditions are present at birth, but the LLD

may not be detectable. As the child grows, the LLD

increases and becomes more noticeable. Examples

include:

 

-Hemimelia: Underdevelopment of the inner or outer

side of the leg is called hemimelia. One of the two

bones between the knee and ankle (tibia or fibula) is

abnormally short. There may also be foot and knee

abnormalities.

 

-Hemihypertrophy: Stimulation of growth of one side of

the body from an unknown cause is called

hemihypertrophy. It is a rare condition.

Hemihypertrophy causes over-growth of both the arm and

leg on the same side of the body. There also may be

differences between the two sides of the face.

 

Sometimes no cause for an unequal extremity can be

determined using current diagnostic methods. This is

called idiopathic.

 

Some differences in limb length are so common that

they are considered normal and need no treatment. For

example, a study of 600 military recruits found that

32 percent had a 5 mm to 15 mm (approximately one

fifth inch to three fifths inch) difference between

the lengths of their two lower extremities; this is a

normal variation. Greater differences may need

treatment if the discrepancy affects a patient's well

being and quality of life.

 

Sources: American Academy of Orthopedic Surgeons;

Mark T. Dahl, M.D.

 

Love,

 

Marilette

 

 

 

 

 

 

 

 

 

 

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