Pediatric orthopedic surgeons have some pretty amazing treatments to help children with problems affecting their bones. One of the most common conditions they see is a leg length discrepancy: a child with one leg that’s shorter than the other. A very small difference is fairly common and usually doesn’t cause any problems. However, once the difference in leg length starts approaching one inch, it can affect a child’s quality of life.
How does it happen? Some children are born with a difference in leg length. Other times it’s the result of an injury, illness or infection. “When the difference is more than three quarters of an inch, it can affect a child’s balance and the way he walks,” says Dr. Roger Widmann, chief of Pediatric Orthopedic Surgery at HSS. “A significant difference in leg length can cause a noticeable limp and make it difficult for a child to run, climb and play.”
One of the ways doctors can equalize leg length is with a procedure called epiphysiodesis. “The surgery enables us to slow down the growth in the longer leg so the shorter leg can catch up,” explains Dr. Emily Dodwell, a pediatric orthopedic surgeon at HSS. “A successful procedure means that by the time a patient stops growing, his or her legs are essentially the same length.”
Dr. Dodwell is leading a study that includes HSS and several other hospitals in the U.S. and Canada to compare two surgical techniques that slow down growth in the longer leg. Both focus on the growth plate, an area of special cells that are multiplying and growing at each end of the long bones. This is where bone growth takes place. The study is enrolling a specific group of patients who will have a predicted leg length discrepancy of three quarters of an inch to two inches when they are finished growing.
With one technique, pediatric orthopedic surgeons remove cells in the growth plate so that the bone stops growing. With the other method, they put screws across the growth plate to restrict further growth.
“We are interested in studying this because these are two very different techniques, and currently, there is no research showing that one is better than the other. We know that both methods work, but we also want to find out if one is easier on the child and if one leads to a quicker recovery or more accurate equalization of length,” Dr. Dodwell explained.
Choosing the best option for children with a difference in leg length is a big decision for parents. Selecting a pediatric orthopedic surgeon at a major center such as HSS helps ensure that a child will receive highly specialized care. When the study is completed in about two years, parents and surgeons will have additional information to help them make an informed decision.