Limb shortening

Limb shortening refers to a condition where one or more of the limbs, such as the arms or legs, are shorter than the average or desired length. It can occur as a result of various factors, including congenital conditions (present at birth), growth plate injuries, bone infections, bone diseases, or previous surgeries. Limb shortening can lead to functional limitations, gait abnormalities, and aesthetic concerns. In some cases, limb lengthening procedures may be performed to correct limb shortening. These procedures involve gradually lengthening the bone using techniques such as the Precice Lengthening Nail or external fixation devices. The goal is to achieve equal limb lengths and improve overall function and symmetry. The specific approach and feasibility of limb lengthening depend on factors such as the patientʼs age, bone health, and the underlying cause of the limb shortening. Limb shortening is an option to manage leg length discrepancy

 (LLD).  Before skeletal maturity, a LLD between 2 and 5 cm can be corrected by epiphysiodesis (open or closed) or stapling. All these procedures require exact timing of surgery. In skeletally mature patients, shortening of the femur is considered safer than tibial shortening. For LLDs greater than 10 cm, lengthening should be considered, although a one-stage two-limb procedure can be used, whereby shortening is performed on the longer limb, and the excised bone segment is implanted in the contralateral limb to be lengthened. However, when shortening procedures are performed in skeletally immature patients, they require precise timing, and indications and technical details must be strictly observed. 

Limb shortening

in adults is divided into two as real and functional. What is meant by functional inequality is not that the leg itself is short, but that the leg appears short due to a problem with the spine or pelvis. There is no anatomical or structural difference between the two legs. In the case of real inequality, there is indeed a visible anatomical or structural difference between the two legs. Actual leg length inequality is divided into three: Developmentally apparent shortness congenital brevity Shortness that may occur due to bone fracture (Post traumatic) If it is necessary to give an example for congenital shortness of the leg, the lack of the femur can be given as an example. Again, examples such as lack of fibula, hemimelia of the tibia, hemi myelomeningocele, idiopathic, hemiatrophy or hemihypertrophy are also suitable examples for congenital shortness. The causes of patients who need leg inequality surgery for developmental reasons are generally congenital problems such as clubfoot, enchondromatosis, neurofibromatosis, osteochondromatosis. Growth problems due to fracture, an infection, exposure to radiation or various other causes are due to traumas. Avicenna Ataşehir Hospital Orthopedics and Traumatology Department specialist physicians can meet all these leg length inequality surgery needs.

How does Limb Shortening work? 

Shortening procedures slow growth of the longer leg so the shorter leg can catch up. This is generally safer and results in fewer complications than limb- lengthening surgery. 

• Epiphysiodesis

  is performed on children who are not yet done growing. The surgeon fuses the growth plate, either temporarily or permanently, to prevent growth in the longer limb. Timing is important in order to avoid over- or under-correction of the legʼs length. 

• Epiphyseal

  stapling uses staples that are surgically inserted on each side of the growth plate. Once the legs are of equal length, the staples are removed. 

• Bone resection

  involves removing a section of bone in the longer leg. This can be performed on adults or adolescents who have reached their adult height. In patients who are finished growing, the longer limb can sometimes be shortened to even out the leg lengths. 

To do this, the doctor removes a section of bone from the middle of the longer limb, then inserts metal plates and screws or a rod to hold the bone in place while it heals.

Because a major shortening may weaken the muscles of the leg, limb shortening cannot be used for significant limb length discrepancies. In the femur (thighbone), a maximum of 7cm can be shortened. In the tibia (shinbone), a maximum of 5 cm can be shortened. 

What is the reason for Limb Shortening surgery? 

Limb lengthening is considered if a person has a large difference in leg length (more than 5 cm). The procedure is more likely to be recommended: 

• For children whose bones are still growing 

• For people of short stature 

• For children that have abnormalities in their growth plate 

• For people that had trauma and it resulted in a shortened or lengthened limb

Leg shortening or restricting is considered for smaller differences in leg length (usually less than 5 cm or 2 inches). Shortening a longer leg may be recommended for children whose bones are no longer growing

Medical reason for Limb Lengthening 

Leg lengthening and shortening are types of surgery to treat some people who have legs of unequal lengths.These procedures

may: 

• Lengthen an abnormally short leg 

• Shorten an abnormally long leg 

• Limit growth of a normal leg to allow a short leg to grow to a matching length 

Cosmetic reason for Limb Lengthening

Limb shortening for cosmetic reasons refers to a surgical procedure performed to deliberately shorten the length of a personʼs limbs in order to achieve a desired aesthetic appearance. This procedure is typically not performed for medical or functional reasons but is instead chosen by individuals who wish to alter their body proportions for personal or aesthetic reasons. It is important to note that limb shortening surgery is a significant and irreversible procedure that carries both physical and psychological considerations, so careful evaluation and consultation with medical professionals is essential for anyone considering such procedure.