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Observation
67%
771/1149
Left tibial lengthening
2%
22/1149
Right tibia epiphysiodesis
24%
278/1149
Right femur epiphysiodesis
6%
65/1149
Amputation
0%
2/1149
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Based on the arithmetic method for prediction of limb length discrepancy, the patient in question has about 2 years of growth remaining, and it can be calculated that his left tibia will be short by about 15 mm at maturity (6mm/yr for proximal tibia x 2 yrs + existing 3mm). Typically, LLD at maturity of <2cm is treated nonoperatively with observation and shoe lift if needed. Treatment is dictated by the length discrepancy at maturity (not at the original presentation): <2cm is treated nonoperatively, 2-5cm is treated with epiphysiodesis or ostectomy, and greater than 5-6cm is treated with limb lengthening, and possible contralateral epiphysiodesis. Stanitski discusses the presentation, prediction of discrepancy, and treatment of leg length discrepancy in children in her review article. The arithmetic method for prediction of limb length discrepancy (LLD) is described as being based on four assumptions about growth: (1) boys stop growing at age 16; (2) girls stop growing at age 14; (3) the distal femoral physis grows 10 mm yearly; and (4) the proximal tibia grows 6 mm yearly. Friend et al review the recent developments in the surgical management of leg length discrepancy, including the use of extraphyseal plates for guided growth, and external fixators to correct length and angular deformity.
4.1
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