From Car Accident to Limb Length Discrepancy: Seeking Solutions

The car accident resulted in a leg length discrepancy?

Hello Dr.
Lee: Three years ago, I had a car accident that resulted in an open and comminuted fracture of my right femur (the bone shattered into several pieces).
I was hospitalized for two weeks and then discharged, but three months later, I was readmitted due to a bacterial infection and stayed for six months (I'm not joking).
Because of the infection, the internal fixator in my thigh was removed, and I had to switch to traction (during this time, I underwent multiple debridements).
I lay in bed for three months until the infection cleared, and then they reinserted the internal fixator.
As a result, my legs are now 3 centimeters different in length.
Even now that my leg has healed, there is still a 3-centimeter discrepancy, and walking is quite painful.
Could you please provide detailed information on what can be done to improve my leg? Additionally, during my hospitalization, I received antibiotics daily (two in the morning and one in the evening).
Could this have any long-term side effects? Thank you, Dr.
Lee, for your response! I am very grateful.
Thank you! (If Dr.
Lee is unavailable, another doctor may respond as well.
Thank you.)

A-Ding, 20~29 year old female. Ask Date: 2004/10/20

Dr. Li Wenlin reply Orthopedics

Hello A-Ding,
In response to your question...
the treatment of osteomyelitis is not easy.
Although there is a three-centimeter difference in the length of your legs, I would like to congratulate you on overcoming the issue of osteomyelitis.
Despite the long duration and the suffering endured, the efforts of your physician, yourself, your family, and the healthcare staff deserve applause.
Regarding the three-centimeter discrepancy, there are generally two approaches: The first approach involves external aids, such as using heel lifts or insoles in your shoes.
Typically, a three-centimeter difference does not require a full three-centimeter lift; sometimes, a lift of one or two centimeters can yield significant clinical results.
The choice of whether to place the lift in the sole or inside the shoe depends on personal preference.
The second approach is surgical treatment, which has various methods.
Given your history of osteomyelitis, I personally do not recommend surgical intervention due to the high risk of reinfection or complications.
If surgery is absolutely necessary for limb lengthening, it is crucial to fully understand the potential risks and complications associated with the procedure.
The choice of surgical method will depend on the type of internal fixation used.
As for the side effects of antibiotics administered during your hospitalization, these typically occur during the hospital stay (as medications have a certain duration of action and are metabolized and excreted over time), so you need not worry about this issue now.
The orthopedic surgeon involved in your treatment understands your situation best.
I recommend discussing any further questions with him, as his advice will likely be the most appropriate given his familiarity with your condition.
Wishing you a swift resolution to your issues.
Best regards,
Li Wen-Lin

Reply Date: 2004/10/20

More Info

Dear Patient,
Thank you for sharing your detailed medical history regarding your car accident and subsequent complications. It sounds like you have been through a very challenging journey, and I appreciate your patience as you seek answers and solutions for your current condition, particularly the limb length discrepancy.

From your description, it appears that you sustained a severe open and comminuted fracture of the right femur, which led to significant complications, including a prolonged hospitalization due to a bacterial infection. The fact that you have a 3 cm discrepancy in limb length after such a traumatic injury is not uncommon, especially following complex fractures and infections that can affect bone healing and growth.

Limb Length Discrepancy
Limb length discrepancy (LLD) can occur for several reasons, including:
1. Bone Healing Issues: After a fracture, especially a complex one, the bone may heal in a way that does not restore its original length. This can be exacerbated by infections that may lead to bone loss or delayed healing.

2. Inactivity: Prolonged immobilization can affect the growth of bones, particularly in younger individuals. In your case, the extended period of bed rest due to infection may have contributed to the discrepancy.

3. Surgical Intervention: The removal of internal fixation devices and the use of traction may also impact how well the bone heals and its final length.

Treatment Options
Addressing a limb length discrepancy typically involves several approaches, and the best option for you will depend on various factors, including your overall health, the condition of your bones, and your personal preferences. Here are some potential treatment options:
1. Physical Therapy: Engaging in a structured physical therapy program can help improve strength, flexibility, and function in your affected leg. While this will not correct the length discrepancy, it can help alleviate pain and improve your overall mobility.

2. Surgical Options: If the discrepancy is significant and causing functional problems, surgical intervention may be necessary. Options include:
- Limb Lengthening Surgery: This involves cutting the bone and using an external or internal device to gradually lengthen the bone over time. This process can take several months and requires careful monitoring.

- Bone Grafting: In some cases, bone grafts can be used to help stimulate healing and potentially correct length discrepancies.

- Osteotomy: This procedure involves cutting and realigning the bone to improve function and alignment.

3. Orthotic Devices: In some cases, using orthotic devices such as shoe lifts can help compensate for the length discrepancy and improve your gait.

Antibiotic Use and Potential Side Effects
Regarding your concern about the prolonged use of antibiotics during your hospitalization, it is essential to understand that while antibiotics are crucial for treating infections, long-term use can have side effects. Potential issues include:
- Antibiotic Resistance: Prolonged use can lead to antibiotic resistance, making future infections harder to treat.

- Gut Health: Antibiotics can disrupt the balance of good bacteria in your gut, potentially leading to digestive issues.

- Other Side Effects: Depending on the specific antibiotics used, there may be other side effects, including allergic reactions or impacts on liver and kidney function.

It is advisable to discuss any concerns about long-term antibiotic use with your healthcare provider, who can monitor your health and suggest appropriate follow-up care.

Conclusion
In summary, addressing your limb length discrepancy and the pain you are experiencing will require a comprehensive approach involving physical therapy, potential surgical options, and careful monitoring of your overall health. I encourage you to consult with an orthopedic specialist who can evaluate your specific situation and recommend the best course of action.

Please take care, and I wish you the best in your recovery journey. If you have any further questions or need clarification on any points, feel free to reach out.

Best regards.

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