Has the Threshold for Epiphysiodesis Versus Lengthening Changed in the Era of Magnetically Controlled Nails?

Szczegóły
Abstrakt

Tytuł:: Has the Threshold for Epiphysiodesis Versus Lengthening Changed in the Era of Magnetically Controlled Nails?
Autorzy:: Nichols LRB; Department of Orthopaedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE.
Źródło:: Journal of pediatric orthopedics [J Pediatr Orthop] 2021 Jul 01; Vol. 41 (Suppl 1), pp. S24-S32.
Typ publikacji:: Journal Article; Review
Język:: English
Imprint Name(s):: Publication: 2000- : Philadelphia : Lippincott Williams & Wilkins
Original Publication: New York Ny : Raven Press
MeSH Terms:: Arthrodesis*/adverse effects
Arthrodesis*/instrumentation
Arthrodesis*/methods
Bone Lengthening*/adverse effects
Bone Lengthening*/instrumentation
Bone Lengthening*/methods
Bone Nails*
Lower Extremity*/growth & development
Lower Extremity*/pathology
Lower Extremity*/surgery
Magnets*
Osteotomy*/adverse effects
Osteotomy*/methods
Leg Length Inequality/*surgery
Adolescent ; Algorithms ; Child ; Humans ; Leg Length Inequality/etiology ; Leg Length Inequality/prevention & control ; Outcome Assessment, Health Care ; Patient Selection ; Risk Assessment
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Entry Date(s):: Date Created: 20210607 Date Completed: 20210719 Latest Revision: 20230829
Update Code:: 20240104
DOI:: 10.1097/BPO.0000000000001801
PMID:: 34096534
: Czasopismo naukowe

Introduction: Limb length discrepancy (LLD) is common in both the pediatric and adult population. Length inequalities can be due to a multitude of etiologies including congenital, developmental, and acquired causes. There has been little consensus on the morbidity of LLD and, as a result, the threshold necessary for treatment of LLD to prevent morbidity. Advances in magnetically controlled lengthening devices achieve greater accuracy and patient satisfaction and create an opportunity to lower the threshold for limb lengthening.
Discussion: Asymptomatic LLD is relatively common in both pediatric and adult populations. Only ~10% of the population has equal leg length. LLD of <5 cm may lead to long-term morbidities such as scoliosis, lower back pain, gait abnormalities, stress on hip or knee joint, and lower extremity symptomatic versus asymptomatic osteoarthritis. The teaching in most orthopaedic textbooks is to adjust the shoe if symptomatic for discrepancies up to 2 cm; consider an orthotic, epiphysiodesis, or skeletal shortening for 2.5 to 5 cm; and possible limb reconstruction for >5 cm. The assumption is that there are no long-term consequences of mild LLD. However, data in recent literature show that small discrepancies may contribute to pathologic changes such as pain, gait abnormalities, and osteoarthritis. Major advances have been made in limb lengthening over the past 40 years. The increased accuracy and superior patient satisfaction of the magnetically controlled lengthening nail versus external fixation methods argue for including lengthening for LLD of <5 cm.
Conclusion: If mild LLD can cause long-term pathology, it is important to counsel families on the full range of options for limb equalization no matter the size of the discrepancy. The evolution in technology and understanding of limb lengthening has provided additional safe surgical options. Therefore, the historic treatment protocol for addressing limb differences may need to include lengthening for smaller discrepancies even <2 cm.
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