Modern view on the problem of the leg length discrepancy in children and treatment using methods of guided growth (literary review)

S.O. Khmyzov, V.S. Rokutov, D.V. Iershov

Abstract


The leg length discrepancy (LLD) is quite common problem in children and adults, which has multietiological nature. According to various authors, frequency of LLD is from 40 to 70 % of the population. The clinical significance of LLD in children is determined by complex biomechanical, anatomical and physiological disorders of the musculoskeletal system. The etiological factor and the degree of LLD (mild, moderate, severe) determine the strategy for further treatment. There are many different surgical methods are used for LLD treatment in children. LLD correction may be performed by shortening of a longer limb or lengthening of a short limb. Methods of LLD correction, the mechanism of action of which are based on controlling the function of the growth plate (GP) of long bones, are promising and have been the subject of close investigation and experimental research for the last 80 years. The modern philosophy in the treatment of orthopedic pathology in children is focused on minimally invasive methods of surgical treatment, so the concept of guided growth, which is based on using various methods influencing the GP function (epiphysiodesis, stapling, PETS-technique, temporary blocking by 8 plates), becomes very popular. The treatment of moderate LLD (3 to 6 cm) in children can be effectively performed using guided growth. Temporary bilateral blocking of the GP with 8 plates is promising direction, because it allows reversible inhibition of growth of a healthy (long) extremity, which significantly extends the indications for the method. It can be concluded that improvement of methods of LLD treatment in children using minimally invasive techniques that influence GP function requires further research.

Keywords


guided growth; treatment for leg length discrepancy; temporary blocking of the growth plate; review

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DOI: https://doi.org/10.22141/1608-1706.4.18.2017.109339

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