Staged Lengthening of 20 cm in the Femur and Tibia to Equalize Leg Lengths in a Growing Child

Although this child initially appeared to be a typical case of congenital LLD, it became apparent that with dysfunction of all the right lower extremity growth plates, a massive LLD would ensue. The LLD was coming from both the femur and tibia. Our plan after the initial femur lengthening was to do a lengthening of the tibia/fibula and then to come back and repeat a femur lengthening. Also planned was an epiphysiodesis of the contralateral side to prevent additional LLD after the last lengthening at age 15. The growth plate shutdown and dysplasia were not well defined despite additional consultation with several pediatric orthopedic colleagues and a geneticist. The main practical issue of LLD was, however, addressed with three well-timed lengthenings and an epiphysiodesis of the long side. This case illustrates an excellent functional and aesthetic outcome following 20 cm (8 in.) of limb lengthening in three stages. Adjuvant procedures including epiphysiodesis, quadricepsplastyQuadricepsplasty, and gastrocnemius recession were all used to achieve limb salvage in this child.