Growth Guidance Surgery for Limb Length Discrepancy in Children

Q: Growth Guidance Surgery for Limb Length Discrepancy in Children

Hello： 1. <br>The risks associated with reverse growth guidance surgery are similar to those of general orthopedic surgeries; however, children tend to have faster healing times and lower risks of nonunion or infection. <br>Side effects may include excessive growth suppression or

Treatment for leg length discrepancy?

Hello Doctor, my daughter has congenital clubfoot on her left foot, and she has been receiving treatment since birth.
She is currently 8 years old.
Aside from a noticeable size difference in the soles of her feet, she also has a leg length discrepancy.
A few days ago, during a follow-up visit, an X-ray showed that her left foot is currently 1.5 cm shorter than her right foot.
The doctor recommended a guided growth surgery in the opposite direction, placing a device on the growth plate of the right foot to slow its growth, allowing the left foot to catch up.
The doctor mentioned that with a 1.5 cm difference, it is estimated that it could take about two years for the left foot to catch up.
I would like to ask the doctor: 1.
Is there a risk of other side effects or complications from the guided growth surgery in the opposite direction? What other risks might be involved? 2.
At what age is guided growth surgery in the opposite direction typically most suitable for children? My daughter is currently 116 cm tall, which is significantly shorter than the average height for her age.
Is this an appropriate time to perform this surgery, or would it be better to wait until she is taller? 3.
If the guided growth surgery is performed, will there still be a chance for her height to increase before the device is removed?

Celia, 0~9 year old female. Ask Date: 2019/05/08

Dr. Li Wenhong reply Orthopedics

Hello: 1.
The risks associated with reverse growth guidance surgery are similar to those of general orthopedic surgeries; however, children tend to have faster healing times and lower risks of nonunion or infection.
Side effects may include excessive growth suppression or uneven growth on the medial or lateral sides, leading to short stature or deformity.
However, when performed by an experienced physician, these side effects are usually minimal.
2.
If the growth plate is not damaged and only clamps are placed (temporarily suppressing growth), the procedure can be performed before the age of 10, with a longer observation and follow-up period, which facilitates timely intervention for clamp removal.
It is recommended that you discuss this with your physician, as it may be possible to proceed this summer.
3.
Before the clamps are removed, the affected growth plate will not grow, but other areas will continue to grow, resulting in an increase in height.
Changhua Hospital, Orthopedics, Dr.
Li Wen-Hong.

Reply Date: 2019/05/08

More Info

Understanding limb length discrepancies in children, particularly in the context of growth guidance surgery, is crucial for parents and caregivers. Your daughter's situation, where she has congenital clubfoot (足內翻) and a measurable discrepancy in limb length, is not uncommon. The proposed treatment, known as "reverse growth modulation" or "growth guidance surgery," aims to address this discrepancy by slowing down the growth of the longer limb (in this case, the right leg) to allow the shorter limb (the left leg) to catch up.

1. Risks and Side Effects of Reverse Growth Modulation Surgery:
Like any surgical procedure, reverse growth modulation carries potential risks and side effects. These may include:
- Infection: As with any surgery, there is a risk of infection at the surgical site.

- Overcorrection: If the growth modulation is too effective, it may lead to the shorter limb becoming longer than the intended length, resulting in a new discrepancy.

- Growth Plate Damage: There is a risk of inadvertently damaging the growth plate, which could affect future growth.

- Pain and Discomfort: Post-operative pain is common, and the child may require pain management.

- Psychological Impact: The child may experience anxiety or stress related to the surgery and recovery process.

However, when performed by an experienced pediatric orthopedic surgeon, the risks can be minimized. The surgeon will monitor the child closely to ensure that the growth modulation is effective and that any potential complications are addressed promptly.

2. Optimal Age for Surgery:
The ideal age for reverse growth modulation surgery typically falls before the child reaches skeletal maturity, which is around 14-16 years for girls and 16-18 years for boys. Since your daughter is currently 8 years old, she is within the appropriate age range for this procedure. Early intervention can be beneficial as it allows for more time to monitor growth and make adjustments if necessary. If your daughter is significantly shorter than her peers, addressing the limb length discrepancy now may help improve her overall function and self-esteem.

3. Growth Potential During Surgery:
After the reverse growth modulation surgery, the growth plate of the longer limb will be temporarily inhibited. This means that while the right leg's growth is slowed, the left leg may continue to grow at its normal rate. However, the overall height of your daughter will still be influenced by her genetic potential and other factors. During the period when the growth modulation device is in place, the child may still experience growth in other areas of her body, but the specific limb being modulated will not grow until the device is removed.

In conclusion, reverse growth modulation surgery can be an effective method to address limb length discrepancies in children. It is essential to have a thorough discussion with your child's orthopedic surgeon about the potential risks, benefits, and the timing of the surgery. Regular follow-ups will be necessary to monitor growth and ensure that the treatment is progressing as planned. Additionally, consider seeking a second opinion if you have any concerns about the proposed treatment plan. Early intervention can lead to better outcomes, and your child's comfort and well-being should always be a priority.

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