Issue

Most common reason for litigation against orthopaedic surgeons in THR

Usually from lengthening

Complications of LLD

1.  Nerve palsy

Sciatic nerve - tolerate average 4.4cm lengthening

Common peroneal nerve - tolerate average 2.7 cm lengthening

Lengthen by up to 15-20% of the resting nerve length

- but in reality is unknown and multifactorial

Epidemiology

Neck involved in 86%

- second most common site after hands and feet

- closely associated with MCPJ subluxation

Associations

Males / Steroid use / Seropositivity Nodules / Severe long standing disease

Conditions

Atlanto-axial subluxation

Subaxial subluxation

Superior migration ondontoid