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