Limb lengthening surgery in children: What parents need to know

Limb lengthening surgery in children: What parents need to know

Limb length discrepancies can affect your child’s mobility, confidence and overall quality of life. While some differences in leg or arm length are minor and cause no issues at all, others may need specialist medical help.

Consultant paediatric orthopaedic and limb reconstruction surgeon Mr Jonathan Wright explores how paediatric limb lengthening surgery works, who it’s suitable for and what parents should consider before going ahead with treatment.

Managing limb length discrepancies in children

If you one of your child’s arms or legs is longer than the other, it’s a good idea to talk to orthopaedic specialist. They’ll be able to tell you whether it’s something minor that just needs monitoring or whether your child may need limb lengthening surgery or another surgical intervention.

More serious limb length differences in children are treated using one of a range of limb length equalisation procedures. Which is best for your child will depend on how severe the discrepancy is, your child’s age and how much growing they still have to do.

If they do need surgery, it’s good to know that limb equalisation procedures can be extremely effective:

• The most common procedure is called epiphysiodesis and it’s usually used to resolve discrepancies in leg length. It involves slowing the growth of the longer leg by targeting one or more of its growth plates. This allows the shorter leg to ‘catch up’ over time and it can be effective in children who are still expected to grow.
• In more severe cases or when a child has minimal growth potential left, we may look at acute shortening. This involves surgically removing a portion of the longer limb to align it with the shorter one.
• Limb lengthening surgery, which involves the gradual lengthening of the bone, is typically considered when the difference in length can’t be addressed with the other methods.

Why might a child need limb lengthening surgery?

There are several reasons why a child may have one limb shorter than the other and need limb lengthening surgery. These include:

• Congenital conditions: some children are born with conditions such as fibular hemimelia or congenital femoral deficiency, which cause one limb to be shorter than the other.
• Growth plate injuries: damage to the growth plate (the area of developing tissue near the ends of long bones) can lead to uneven growth.
• Infections or diseases: conditions like osteomyelitis (bone infection) or skeletal dysplasia, can affect bone growth.
• Trauma: fractures or injuries sustained during childhood may interfere with normal bone growth, leading to a length difference.

What does paediatric limb lengthening surgery involve?

This procedure is designed to gradually increase the length of a child’s bone, most commonly in the legs. It achieves this using a specialised technique called distraction osteogenesis. This can help children who are born with limb length discrepancies as well as those who develop them due to injury or medical conditions.

The technique involves carefully cutting the bone and allowing it to grow over time with the help of an externally or internally fitted device. The process allows new bone to form in the gap created. As the bone heals, it becomes strong and functional.

How the procedure works

Limb lengthening surgery can be divided into four stages:

1. Surgical preparation: a controlled cut (osteotomy) is made in the bone to allow it to be gradually stretched apart.
2. Bone distraction phase: a specialised device, like an external fixator or an internal lengthening rod, is used to slowly separate the bone. A parent or the child (under medical supervision) adjusts the device daily, usually by about 0.5mm to 1mm, depending on the child’s condition. This phase typically lasts several weeks to months.
3. Bone consolidation phase: once the bone reaches the desired length, it’s left to heal and harden, which can take several months. During this period, continued medical monitoring ensures proper bone formation and positioning.
4. Rehabilitation and physiotherapy: throughout the process, children require physiotherapy to maintain muscle strength, joint flexibility and overall mobility. Weight-bearing activities are gradually introduced based on the surgeon’s recommendations.

Is limb lengthening surgery painful?

While limb lengthening surgery is a major procedure, the gradual nature of the process allows the body to adapt. Pain management techniques, including medication and physiotherapy help to keep discomfort under control.

What are the risks and complications?

A skilled paediatric orthopaedic surgeon will carefully plan and monitor the procedure, but like any surgery, limb lengthening surgery comes with some risks. These may include:

• Infection - especially if an external fixator is used
• Muscle or joint stiffness
• Uneven bone growth
• Delayed bone healing
• Temporary difficulty with mobility
• Nerve irritation or damage
• Joint subluxation or dislocation if the soft tissues fail to adapt to the process

Regular follow-ups, physiotherapy, and following the medical advice you’re given will all help to reduce complications. Parents should also be aware that the limb lengthening process and recovery require time, patience, and commitment.

What results can we expect to see?

Most children achieve excellent outcomes with limb lengthening surgery, resulting in a more equal limb length and improved limb function and mobility. Although the treatment can take several months to complete, the benefits of correcting a significant limb length discrepancy can be lifechanging.