LLD Aetiology

A.  General Conditions

 

Hemi-hypertrophy or atrophy

 

Idiopathic

Klippel-Trenaunay-Weber syndrome

Proteus syndrome

Beckwith-Weiderman syndrome

Russel-Silver syndrome (atrophy)

 

Skeletal dysplasia

 

Chondrodysplasia punctata

Ollier's / Maffuci's

Multiple hereditary exostoses

NF

Fibrous dysplasia

 

Neurological

 

Closed HI

Polio

Spina bifida

CP

Spinal dysraphism / tumor / injury

Peripheral nerve injury

 

B.  Specific Regions

 

Tumour / trauma / infection / radiotherapy physis

 

Hip

- PFFD

- Coxa vara

- SUFE

- DDH

- Perthe's

- Tom Smith arthritis / post septic arthritis

 

Femur

- congenitally short femur

 

Leg

- fibula hemimelia

- tibial hemimelia

- bowing

 

Foot

- CTEV

 

Effect of LLD

 

Initially thought gives pain in back and contralateral knee and hip

- this may be debatable

 

1.  Short leg gait

- increased energy expenditure is the only proven effect of LLD

 

2.  Back 

- pelvic tilt and secondary scoliosis

- initially compensatory

- can become fixed

- ? causes LBP - now thought no different from general population

- most children's spines adapt (not so with adults)

- up to 2 cm easily tolerated

 

3. Contralateral Hip 

- uncovering of hip on long leg side in stance

- AKA long leg arthropathy

- ? increased OA 

- no evidence 

 

4.  Contralateral Knee 

- ? increased knee pain in athletes

 

Growth

 

2° Proliferative Zone chondrogenesis

 

Proximal Femur

- 3mm / year

- 15% leg

 

Distal Femur

- 9mm  / year

- 37% leg

- 70% of femur

 

Proximal Tibia

- 6mm / year

- 28%

- 60% tibia

 

Distal Tibia

- 3mm / year

- 20%

 

Growth Cessation

 

14-15 Girls

16-17 Boys

 

Relationships

 

LL vs Chronological Age

- steady growth occurs

- growth spurt in early adolescence

 

LL vs Skeletal Age 

- Green & Anderson curves

- Growth vs Skeletal age

- shows no growth spurt

- because growth spurt & maturation spurt occur together

 

Skeletal Age & Chronological Age

- maturation can occur at different rates

- if early, are tall early & stop growing early

- can have spurt where mature more than age

- pass through skeletal ages more quickly

 

History

 

Determine cause

Determine deformity