Limb length discrepancy (LLD) after lower limb long bone fractures in pediatric age group

Abstract

Background: It has been mentioned that Limb length discrepancy may vary with the age of child, position of fracture and the type of treatment done (ORIF-open reduction and internal fixation/CRIFclosed reduction and internal fixation/Conservative). This treatment methods influence the amount of overriding after reduction of fracture. Aims and Objectives: To determine the Limb Length Discrepancy (LLD) developing after lower limb long bone fractures in age group 2 years to 16 years. Methodology: They were 20 patients, with history of lower limb long bone fracture with minimal duration post fracture of 6 months. Subject particulars were recorded as per methodology protocol by two different observers. Results:The study group ranged from 3 years to 16 years with mean age of 8.5 years. There were eleven males and nine females. Seven out of twenty patients managed conservatively with plaster application and Open reduction and plating done for 8 patients. Remaining five patients were treated with closed reduction and fixation with either Titanium Elastic nails or external fixator. Post op X ray showed no overriding in eight patients and all were from the group managed by open reduction and plate fixation. Fractures managed by closed reduction found to have over riding which was less than 1 cm in four subjects and 1cm to 2cms in remaining five cases. LLD when measured, it ranged between -1cms to +3cms (mean +1 cm). Three post fracture limb has no Limb Length Discrepancy (LLD) at all. There was lengthening seen in rest of patients it was up to 1 cm in 10 and more than 1cm in five cases.2 patients out of 20 patients developed significant lengthening and presented with limp, so they underwent epiphysiodesis near skeletal maturity. Conclusion:There is need to educate parents and budding orthopedic surgeons regarding the importance of conservative management and acceptance of some degree of allowable mal-alignment. The fractures in pediatric age groups need to be followed till skeletal maturity as there is associated risk of developing LLD during the course of fracture union. This LLD sometime needs intervention in the form of timely epiphysiodesis at the time of near skeletal maturity.