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Limb Lengthening / Limb Deformity

The staff at the Hospital for Joint Diseases Center for Children have spoken nationally on the subject of Limb Lengthening and Limb Deformity, and are experts in the field. With varied methods to treat the condition, from surgical intervention to exercises, children can be effectively treated in a myriad of ways.

Definition
Limb defects occur when a portion of the fails to form normally when the baby is developing in utero or, can be caused some kind of trauma or a tumor or infection that has left their limb short or crooked. A variety of procedures are used for the patient with limb length inequalities and upper and lower extremity deformities.

Causes
The cause of congenital limb defects is unknown.

Risk Factors
As the cause is unknown, risk factors are generally unknown as well.

Symptoms

Diagnosis
Diagnosis is done through examination by a physician.

Treatment
Surgical Care
With the Ilizarov Method, a proven technique for correcting limb deformity, a frame is attached to the outside of a limb, using pins and wires such as with the Taylor Spatial Frame and the Monolateral Fixator. Over time, the frame is gradually adjusted until the shape and length of the leg are corrected. The Hospital for Joint Diseases Center for Children uses different devices to lengthen limbs or deal with limb deformity including rods and plates. Lengthening with rods is also used.
Another method used by the Hospital for Joint Disease Center for Children, Distraction Osteogenesis, is a process in which the bone is cut during surgery and slowly distracted, allowing for new bone to form in the lengthened space between the cut bone ends.

Non-surgical Care
Splints or braces can be used with this condition, in addition to treating the patient with physical and occupational therapy.

Prevention
There is no known way to prevent limb defects.

Resources
The New York Institute for Limb Lengthening and Reconstruction
http://www.med.nyu.edu/hjd/centerforchildren/patient/limb.html

The Wallace B. Lehman, M.D. Center for Pediatric Orthopedic Surgery
http://www.nyuhjd.org/hjd/centerforchildren/patient/wallace.html

The Center for Pediatric Rehabilitation and Pediatric Medicine
http://www.nyuhjd.org/hjd/centerforchildren/patient/ped_rehab.html

The NYU Hospital for Joint Diseases Pediatric Physical and Occupational Therapy Department
http://www.nyuhjd.org/hjd/centerforchildren/patient/rehabilitation.html

Child Life Program at Center for Children
http://www.nyuhjd.org/hjd/centerforchildren/patient/child_life.html

Music Therapy at Center for Children
http://www.nyuhjd.org/hjd/centerforchildren/patient/music_therapy.html

Relevant Publications

Lehman WB, Abdelgawad AA, Sala DA. Congenital tibial dysplasia (congenital pseudoarthrosis of the tibia): an atypical variation. (Point of view) Journal of Pediatric Orthopaedics B 2009;18:211-213.

Feldman DS, Duncan D, Ustunkan F, Kummer FJ. Anatomic and radiographic study to ensure accurate positioning of tension band plates (8 plates). Presented at POSNA in Boston, April 29-May 2, 2009.

Marangoz S, Feldman DS, Sala DA, Hyman JE, Vitale MG. Femoral deformity correction in children and young adults using Taylor spatial frame. Clinical Orthopaedics and Related Research 2008;466:3018-3024.

Henderson ER, Feldman DS, Lusk C, van Bosse HJP, Sala DA, Kummer FJ. Conformational instability of the Taylor spatial frame: a case report and biomechanical study. Journal of Pediatric Orthopaedics 2008;28:471-477.

Feldman DS, Henderson ER, Levine HB, Schrank PL, Koval KJ, Patel RJ, Spencer DB, Sala DA, Egol KA. Interobserver and intraobserver reliability in lower-limb deformity correction measurements. Journal of Pediatric Orthopaedics 2007;27:204-208.

Feldman DS, Madan SS, Ruchelsman DE, Sala DA, Lehman WB. Accuracy of correction of tibia vara: acute versus gradual correction. Journal of Pediatric Orthopaedics 2006;26:794-798.

Anand A, Feldman DS, Patel RJ, Lehman WB, van Bosse HJP, Badra MI, Sala DA. Interobserver and intraobserver reliability of radiographic evidence of bone healing at osteotomy sites. Journal of Pediatric Orthopaedics B 2006;15:271-272.

Ruchelsman DE, Madan SS, Feldman DS. Genu valgum secondary to focal fibrocartilaginous dysplasia of the distal femur. Journal of Pediatric Orthopaedics 2004;24:408-413.

Feldman DS, Shin SS, Madan S, Koval KJ. Correction of tibial malunion and nonunion with six axis analysis deformity correction using the Taylor spatial frame.  Journal of Orthopaedic Trauma 2003;17(8):549-554.

Feldman DS, Madan SS, Koval KJ, van Bosse HJP, Bazzi J, Lehman WB. Correction of tibia vara with six-axis analysis and the Taylor Spatial Frame.  Journal of Pediatric Orthopaedics 2003:23:387-391.