Multiplier Method for Predicting Limb-Length Discrepancy*

Paley, Dror; Bhave, Anil; Herzenberg, John E.; Bowen, J. Richard

doi:10.2106/00004623-200010000-00010

Cited by 306 publications

(210 citation statements)

References 28 publications

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“…Using formulae derived from the multiplier method described by Paley et al, predicted developmental and congenital femoral length discrepancy, predicted congenital overall limb length discrepancy, and growth stimulation or inhibition were calculated [28][29][30][31][32][33]. The congenital method of predicted limb length discrepancy uses the inhibition to predict future growth, whereas the developmental method uses radiographs at two known time points to predict growth at a future time point.…”

Section: Methodsmentioning

confidence: 99%

Lengthening With External Fixation Is Effective in Congenital Femoral Deficiency

Prince

Herzenberg

Standard

et al. 2015

Clin Orthop Relat Res

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Background Treatment of congenital femoral deficiency is a complex, multistage protocol and a variety of strategies have been devised to address joint instability, limb length inequality, and deformities. Despite being an important part of the algorithmic approach to the overall treatment of patients with congenital femoral deficiency, a reproducible, safe, and functional treatment for femoral length discrepancy in patients with mild and moderate congenital femoral deficiency has not been reported. Questions/purposes (1) Does femoral lengthening by means of distraction osteogenesis, using a monolateral external fixator, result in effective lengthening without loss of hip or knee range of motion? (2) Does femoral lengthening cause an inhibition of femoral growth in patients with congenital femoral deficiency? (3) Do patients/families report satisfactory functional and emotional outcomes after undergoing femoral lengthening? (4) (Schaumburg, IL, USA), Pega Medical, and Springer (New York, NY, USA) outside the submitted work. The institution of one or more of the authors (JEH, SCS, DP) has received, during the study period, funding from Smith & Nephew, DePuy Synthes, Orthofix, Biomet, and OrthoPediatrics. One or more of the authors certifies that he (SCS), or a member of his or her immediate family, has received or may receive payments or benefits, during the study period, an amount less than USD 10,000 from Smith & Nephew, an amount less than USD 10,000 from Ellipse Technologies, and an amount less than USD 10,000 from Orthofix. One or more of the authors certifies that he (DP), or a member of his or her immediate family, has received or may receive payments or benefits, during the study period, an amount of USD 100,001 to USD 1,000,000 from Orthofix, Inc during the period of this study. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. 123Clin Orthop Relat Res (2015) 473:3261-3271 DOI 10.1007 Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons® 1a, 1b, or 2a that had not previously undergone lengthening and had stable hip and knee joints. Of the 32 patients that completed treatment, 30 (94%) were available at a minimum of 2 years (mean, 3 years; range, 2-4.5 years) and were evaluated in this retrospective study. Preoperative and postoperative radiographic analysis, physiotherapy data, patient-based outcomes s...

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Section: Methodsmentioning

confidence: 99%

Lengthening With External Fixation Is Effective in Congenital Femoral Deficiency

Prince

Herzenberg

Standard

et al. 2015

Clin Orthop Relat Res

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“…This index was greatly influenced by the scale published by Paley et al [18] for rating the level of difficulty of femoral lengthening procedures, which accounted for angulation of the deformity, tibial lengthening, joint instability, knee flexion and deformity, joint osteoarthrosis, bone quality, soft tissue quality, and associated medical problems. The reliability and validity of their rating scale has not been evaluated, but many of the components have been incorporated into this index.…”

Section: Methodsmentioning

confidence: 99%

“…In a similar fashion, Pappas [19] proposed a nine-category classification system to cover the spectrum of femoral deficiency that later was modified by Paley [17]. The only rating system that has been developed evaluates femoral length discrepancies, but it has yet to be validated [18]. Currently, there are no validated rating systems for determining the severity of general lower limb deformities.…”

Section: Introductionmentioning

confidence: 99%

Limb Lengthening and Reconstruction Society AIM Index Reliably Assesses Lower Limb Deformity

McCarthy

Iobst

Rozbruch

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Although several systems exist for classifying specific limb deformities, there currently are no validated rating scales for evaluating the complexity of general lower limb deformities. Accurate assessment of the complexity of a limb deformity is essential for successful treatment. A committee of the Limb Lengthening and Reconstruction Society (LLRS) therefore developed the LLRS AIM Index to quantify the severity of a broad range of lower extremity deformities in seven domains.Questions/Purposes We addressed two questions: (1) Does the LLRS AIM Index show construct validity by correlating with rankings of case complexity? (2) Does the LLRS AIM Index show sufficient interrater and intrarater reliabilities? Methods We had eight surgeons evaluate 10 fictionalized patients with various lower limb deformities. First, they ranked the cases from simplest to most complex, and then they rated the cases using the LLRS AIM Index. Two or more weeks later, they rated the cases again. We assessed reliability using the Kendall's W test. Results Raters were consistent in their rankings of case complexity (W = 0.33). Patient rankings also correlated with both sets of LLRS AIM ratings (r 2 = 0.25; r 2 = 0.23). The LLRS AIM Index showed interrater reliability with an intraclass correlation (ICC) of 0.97 for Trial 1 and 0.98 for Trial 2 and intrarater reliability with an ICC of 0.94. The LLRS AIM Index ratings also were highly consistent between the attending surgeons and surgeons-in-training (ICC = 0.91). Conclusions Our preliminarily observations suggest that the LLRS AIM Index reliably classifies the complexity of lower limb deformities in and between observers.

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“…Pre-conditions are, therefore, discrepancies of 2-5 cm in individuals with adequate growth left and taller than the 50th percentile for height (women 164 cm, men 176 cm). Since timing is crucial, the prediction of remaining growth and final leg length discrepancy is a condition sine qua non [68,69]. Acute shortening by bone resection followed by gradual lengthening is a possible strategy for complex fractures, infected non-union, congenital pseudarthrosis, osteomyelitis and bone tumours [70][71][72][73].…”

Section: Alternatives To Operative Lengtheningmentioning

confidence: 99%

Current concepts of leg lengthening

Hasler

Krieg

2012

Journal of Children's Orthopaedics

102

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Any lower limb discrepancy may be equalised by conservative means (insoles, prosthesis and orthosis). However, their long-term acceptance is low in regard to function, costs, expenditure and appearance. Timely epiphysiodesis is the best option in uniplanar deformities with adequate remaining growth and for patients whose predicted final body height is above the 50th percentile. However, many patients present late or with multi-planar deformities, which warrant more sophisticated operative approaches. The history of surgical bone lengthening comprises 100 exciting years of struggling, development and ongoing learning. The initial strategy of acute or rapid incremental distraction had lasted almost half a century until Ilizarov recognised the benefits of biological periosteum-preserving osteotomies and incremental lengthening at slow rates (1 mm/day) at a 4 × 0.25-mm daily rhythm, well appreciated as callotasis. In parallel, ring and wire constructs made complex three-dimensional axial, translational and rotational bone moulding possible. Taylor Spatial Frames—built on hexapod strut-linked platform technology as known from flight simulators—took limb correction to a more reliable, more precise and aesthetical level, all the more that the whole process became web-based. It represents state-of-the-art methodology and technology for complex, multi-plane deformities. Due to the significant risk of secondary malalignment, indications for lengthening by unilateral fixation have shrunken to moderate amounts of length disparity and uni- to bi-planar deformities in patients with still open physes. Mechanical or motorised, minimally invasively placed nails prevent muscle fixation and, therefore, ease rehabilitation, increase patient comfort and potentially shorten the overall time of sick leave and refrain from sports activities. Hence, they offer a valuable alternative for low-grade complexity situations. It remains to be proved if the significantly higher implant costs are compensated by lower treatment costs. Overall, limb lengthening, particularly in combination with multi-planar deformity correction, can still be an arduous endeavour. In any case, wise judgement of the patient’s deformity, medical and biological situation, psychosocial environment, selection of the appropriate method and hardware, as well as meticulous operating technique by an experienced surgeon are the cornerstones of successful outcomes.

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Multiplier Method for Predicting Limb-Length Discrepancy*

Cited by 306 publications

References 28 publications

Lengthening With External Fixation Is Effective in Congenital Femoral Deficiency

Lengthening With External Fixation Is Effective in Congenital Femoral Deficiency

Limb Lengthening and Reconstruction Society AIM Index Reliably Assesses Lower Limb Deformity

Current concepts of leg lengthening

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