Leg length discrepancy in children occurs chiefly as an aftermath of poliomyelitis. In spite of immunization, there remain a few infantile paralysis patients with significant leg length discrepancy. The methods to correct leg length inequality have included epiphysiodesis, long bone shortening and growth stimulation. But the limitation of accomplishing equalization by these methods has made it clear that there is a need for an accurate and uncomplicated leg lengthening method. Anderson and others devised a well controlled distraction apparatus and performed surgery upon many, cases with few complications. This study is a report of 7 consecutive patients all operated on by a reverse method, with the application of the Charnley compression apparatus. The results are as follows. 1. Correction of 2. 5 to 4. 5 cm (average 3.4 cm) was achieved. 2. Major complications were delayed union in 5 cases, pin tract infection in 2 cases and nerve injury in 1 case. 3. When either inadequate union or failure of union of the distracted fragments is established in the mature patients, it is suggested that the fragments should be stabilized with bone graft as soon as possible.
Child ; Humans ; Immunization ; Leg ; Leg Length Inequality ; Methods ; Poliomyelitis ; Transplants

BACKGROUND: Sacral slanting is a frequent unique phenomenon in patients with adolescent idiopathic scoliosis (AIS) and may be important for selecting the distal fusion level. However, the reason of the phenomenon remains unknown. The purpose of this study was to determine the association between sacral slanting and adjacent structures in patients with AIS. METHODS: A total of 303 AIS patients who underwent both whole spine standing anteroposterior (AP) and whole leg standing AP radiography were included. The degree of sacral slanting, pelvic obliquity, lumbar curve angles (L1-L4), and L4 tilt were assessed on whole spine standing AP radiographs. Whole leg standing AP radiographs were used to assess the degree of leg length discrepancy (LLD). Demographic data and radiological parameters were analyzed descriptively. Pearson correlation analysis and partial correlation analysis of the parameters were performed. A p-value of less than 0.05 was considered statistically significant. RESULTS: The proportion of patients with ≥ 5° of sacral slanting among those with < 3° of pelvic obliquity was 8.9% (27/303). Thirty-two patients (10.6%, 32/303) showed more than 10 mm of LLD. Sacral slanting was positively correlated with pelvic obliquity and lumbar curve (r = 0.445 and r = 0.325, respectively). Pelvic obliquity was also correlated with LLD and L4 tilt (r = 0.123 and r = 0.311, respectively). However, partial correlation analysis showed that LLD was not directly correlated with sacral slanting (r = −0.034). CONCLUSIONS: Sacral slanting can be thought to be a compensatory mechanism for large lumbar curves, which is accompanied by pelvic obliquity. In contrast, a congenitally slanted upper sacrum may contribute to scoliosis in some cases. LLD was not directly correlated with sacral slanting.
Adolescent* ; Humans ; Leg ; Leg Length Inequality ; Pelvis ; Radiography ; Sacrum ; Scoliosis* ; Spine

PURPOSE: To compare the radiological and clinical results of Wayne-County reduction with anatomical reduction in treatment of the intertrochanteric fractures of the femur in elderly patients. MATERIALS AND METHODS: Among one hundred-three of intertrochanteric fractures treated with 135- degree angled compression hip scresw, eighty three cases treated by Wayne-County reduction (Group 1, 42 cases) and anatomical reduction (Group 2, 41 cases) with at least 1 year follow-up were reviewed. The average pateint ages were 72.4 (65~92) in group 1, 71.6 (65~89) in group 2, respectively. 33 cases (75.2%) in group 1 and 31 cases (77.5%) displayed unstable fractures by Jensen classification. The radiological observation was included neck-shaft angle, penetrating length of lag screw into head, sliding length of lag screw and time of bony union. The clinical results were evaluated by Koval criteria, Kyle's functional evaluation, leg length inequality and complications. RESULTS: There were no significant changes between group 1 and group 2 in stable fractures in the radiological and clinical results. In unstable fractures, the neck-shaft angle averaged 132.2 degree in group 1 and 129.4 degree in group 2 in the final follow-up films. The penetrating length of lag screw into head were 2.2 mm in group 1 and 3.1 mm in group 2 (p<005). But there were little differences in the sliding length of lag screw, the time of bony union and complication rates between groups. In post- operative evaluation of walking abilility by Koval, 31 patients (73.8%) in group 1 and 28 (68.3%) recovered the activity level before injury by the postoperative 1 year follow-up. Leg length discrepancy at final follow-up was 4.1+/-6 mm shortening in group 1 and 6.5+/-8 mm in group 2, respectively. CONCLUSION: Both Wayne-County reduction and anatomical reduction had a favorable results after treatment of stable intertrochanteric fractures of the femur, but Wayne-County reduction may be a better method in treatment of unstable fractures, especially in elderly patients, in which it is difficult to obtain anatomical reduction.
Aged* ; Classification ; Femur* ; Follow-Up Studies ; Head ; Hip ; Hip Fractures* ; Humans ; Leg ; Leg Length Inequality ; Walking

PURPOSE: To analyze the results of cementless total hip arthroplasty with a F2L Multineck femoral stem. MATERIALS AND METHODS: A total of 64 patients (73 hips), who underwent cementless total hip arthroplasty with a F2L Multineck femoral stem, SPH acetabular cup and a ceramic liner from December of 1998 to October of 2001 were followed up for at least 4 years, were selected for the clinical and radiological evaluations. RESULTS: At the final evaluation, 63 patients had an improved average Harris hip score ranging from 51.4 preoperatively to 95.1. None of the patients had any significant leg length inequality. Thigh or inguinal pain was observed in 3 hips (1 hip of femoral stem subsidence and 2 hips of damaged ceramic parts), for which revision total hip arthroplasty was performed. Hip dislocation occurred in 2 hips within 2 weeks after surgery and conservative management was performed after a closed reduction. CONCLUSION: Total hip arthroplasty with a F2L Multineck femoral stem produced satisfactory results. Postoperative complications such as hip dislocation and leg length inequality could be minimized by modulating the anteversion angle, femoral offset and leg length with multineck femoral stem.
Acetabulum ; Arthroplasty, Replacement, Hip* ; Ceramics ; Hip ; Hip Dislocation ; Humans ; Leg ; Leg Length Inequality ; Postoperative Complications ; Thigh

PURPOSE: This study was conducted to compare cemented and cementless bipolar hemiarthroplasty in elderly patients with unstable intertrochanteric fractures via meta-analysis and systematic review of relevant studies. MATERIALS AND METHODS: Systematic review and meta-analysis were performed on 31 available clinical studies; 19 of these studies used cemented stems, 12 used cementless stems, one used both types of stems, and two studies involved a comparative analysis of both stem types. RESULTS: There were statistically significant differences in rates of leg length discrepancy (LLD) greater than 1 cm between the cemented (event rate, 0.089) and cementless groups (event rate, 0.015 and 0.047; P=0.03). CONCLUSION: Cemented bipolar hemiarthroplasty and cementless bipolar hemiarthroplasty performed on elderly patients with unstable intertrochanteric fracture revealed similar mortality and complication rates; however, the rate of LLD greater than 1 cm was significantly higher in the cemented group compared with the cementless group.
Aged ; Hemiarthroplasty ; Hip ; Hip Fractures ; Humans ; Leg ; Leg Length Inequality ; Mortality

OBJECTIVE: To evaluate the association between progression of curvature of scoliosis, and correction for functional component in patients with juvenile idiopathic scoliosis (JIS). METHODS: We retrospectively reviewed medical data of patients prescribed custom molded foot orthosis (FO) to correct inequality of RCSPA (resting calcaneal stance position angle), and chose 52 patients (26 females, 26 males) with Cobb angle ≥10° in radiology and uneven pelvic level at iliac crest by different RCSPA (≥3°) as a factor of functional scoliosis. They had different hump angle ≥5° in forward bending test, for idiopathic scoliosis component. Their mean age and mean period of wearing FO were 79.5±10.6 months and 18.6±0.70 months. RESULTS: Cobb angle was reduced from 22.03°±4.39° initially to 18.86°±7.53° after wearing FO. Pelvis height difference and RCSPA difference, were reduced from 1.07±0.25 cm initially to 0.60±0.36, and from 4.25°±0.71° initially to 1.71°±0.75° (p < 0.01). Cobb angle improved most in 9 months. However, there was no significant improvement for those with more than 25° of Cobb angle initially. Mean Cobb angle improved in all age groups, but patients less than 6 years had clinically significant improvement of more than 5°. CONCLUSION: JIS can have functional components, which should be identified and managed. Foot orthosis is useful in correcting functional factors, in the case of pelvic inequality caused by different RCSPA, for patients with juvenile idiopathic scoliosis.
Female ; Foot Orthoses ; Fungi ; Humans ; Leg Length Inequality ; Pelvis ; Retrospective Studies ; Scoliosis* ; Socioeconomic Factors ; Spine*

The purpose of this experiment was to determine the effect of dividing the periosteum circumferentially on the growth of long bones and the effect of partial division of the periosteum on the formation of angular deformity of growing bones and to investigate the tethering effect of the periosteum on the epiphyseal plate as its possible mechanism. One hundred twenty rabbits, one-month old with average weight of 570g, were divided into four groups. In the first group, the periosteum of the right distal femur was completely divided circumfer- entially; in the control group, the medial aspect of the right distal femur was surgically approached but the periosteum was not divided, in the third group, the medial half of the peristeum of the right distal femur was divided transversely; in the fourth group, the medial half of the periosteum was divided and resutured. Following the operation, X-rays were taken every two weeks until twelfth week and then at twentieth week and the length of the femur and the physis-shaft angle were measured. l. After complete circumferential division of the periosteum, the ratios of right over left femoral length before operation, and two, four, six, eight, ten, twelve, and twenty weeks postoperatively, were 100.0±0.0%, 102.1±0.1%, 102.±0.0%, 102.9±0.0%, 103.5±0.0%, 103.6±0.0%, 103.5±0.0%, and 103.5±0.0%, respectively. The overgrowth was most conspicuous during the first two weeks. On the other hand, in the control group there was slight overgrowth, but this was not statistically significant. 2. After partial division of the periosteum, the physisvhaft angles before operation, and two, four, six, eight, ten, twelve, and twenty weeks postoperatively, were 91.0±1.2, 87.8±2.5,84.4±2.4, 83.1±3.2, 84.2±3.5, 86.4±2.3, 86.2±2.3, and 86.8±1.9, respectively. The valgus deformity was induced most conspicuously during the first four weeks, whereas partial correction of the de- formity took place between the eighth and tenth week postoperatively. After repair of the partially divided periosteum, only 0.9 of angular deformity was observed at sixth week, but this became statistically insignificant at tenth week as were in the complete division and control groups. 3. Histologically, no difference was observed in the cartiage cells of the epiphyseal plate and the bony trabeculae of the metaphysis between the control group and other groups. The divided periosteum regenerated at the ninth week, this being same also in the repaired group. There was no statistical difference in the thickness of the epiphyseal plate between the operated femur and the opposite normal femur in the completely divided group, this being same in the control group. Threr was also no statistical difference in the thickness of the epiphyseal plate between the medical and lateral halves in the partially divided group, this being same in the repaired group. Based on these results, the investigator was able to draw following conclusions. 1. In the growing long bone, complete circumferential division of the periosteum near the epiphyseal plate results in stimulation of growth and lengthening of bone. 2. Partial transverse division of the periosteum results in asymmetrical overgrowth, inducing an angular deformity. 3. It is suggested that the mechanism of overgrowth following division of the periosteum lies in the removal of the tethering effect of the periosteum. These findings may bear clinical implications on leg length inequality and angular deformities following certain fractures and epiphyseal injuries during growth period.
Bone Lengthening ; Congenital Abnormalities ; Femur ; Growth Plate ; Hand ; Humans ; Leg Length Inequality ; Periosteum ; Rabbits ; Research Personnel

OBJECTIVE: To investigate the effect of different proximal femoral shapes on leg length discrepancy(LLD) after total hip arthroplasty(THA). METHODS: Total 131 patients with osteoarthritis or osteonecrosis received unilateral biological total hip arthroplasty from June 2013 to June 2019. All patients' age, sex, side and pelvis anteroposterior digital radiography were retraspectively analyzed. There were 69 males and 62 females, 57 cases of left hip and 74 cases of right hip. The age ranges from 25 to 89 with an average age of 62 years. There were 48 cases of osteoarthritis and 83 cases of osteonecrosis. In this study, femoral cortical index (FCI) was used as the classification of proximal femoral shape, and bilateral lower limb length differences were measured by preoperative and postoperative pelvis anteroposterior digital radiography. Grouping according to FCI:> 0.6 was Dorr A group, 0.5 to 0.6 was Dorr B group, <0.5 was the Dorr C group, and the relationship between proximal femur morphology and the leg length discrepancy after total hip arthroplasty was determined. RESULTS: The postoperative average FCI was(0.56±0.08) mm and the median LLD was 5.10 mm (IQR -1.00 to 8.80 mm). Three groups were divided according to the level of FCI, and there were no statistically significant differences in gender, age, side, diagnosis and intraoperative fracture rate distribution among three groups. FCI>0.6, the postoperative LLD was 6.30 mm (IQR 1.00 to 10.95 mm). When FCI was 0.5 to 0.6, the postoperative LLD was 5.85 mm(IQR-0.55 to 8.90 mm). FCI<0.5, the postoperative LLD was 1.95 mm(IQR -2.50 to 6.68 mm). LLD comparison of different proximal femoral shape was statistically significant ( CONCLUSION High FCI increases the risk of lower extremity prolongation after surgery on the affectedside, while low FCI reduces the risk of lower extremity prolongation after surgery on the affected side. The surgeon can assess the shape of the proximal femur of the patient preoperatively and inform the patient in advance of possible changes in leg length of both lower extremities after total hip replacement.
Arthroplasty, Replacement, Hip/adverse effects* ; Female ; Femur/surgery* ; Humans ; Leg ; Leg Length Inequality/etiology* ; Male ; Middle Aged ; Retrospective Studies

We presented a case which showed clinical improvements after fabricating new ortho-prosthesis to a patient with severe leg length inequality. He was 51 years old and had developed the leg length inequality on the right due to osteomyelitis that he experienced when he was seven. He had been using the orthosis fabricated by a private orthotic shop for more than twenty years from his twenties. We prescribed a new ortho-prosthesis composed of patellar tendon bearing ankle foot orthosis combined with endoskeletal shank and dynamic SACH foot. With this new ortho-prosthesis, there were significant improvements in initial abnormal gait patterns of excessive knee flexion at mid-stance and decreased maximal knee flexion peak at swing phase in the kinematic parameters on transverse plane. And step width, step length and step time were also improved. He got pain relief and improvement of gait endurance
Ankle ; Foot ; Foot Orthoses ; Gait ; Humans ; Knee ; Leg Length Inequality* ; Leg* ; Middle Aged ; Orthotic Devices ; Osteomyelitis ; Patellar Ligament

This is a follow up study on consecutive series 50 patients of total hip arthroplasty to assess for transient leg-length inequality. The authors report a clinical experience of 50 patients who have been pelvis tilt before total hip replacement. Retrospectively reviewed for the presence of pelvic obliquity preoperative and at the 1, 3 and 6 months follow-up visits. The results were as follows. Fourty-eight patients(96%) with functional leg length inequality related pelvic obliquity were improved within 6months postoperative follow up period after total hip arthroplasty. Two patients(4%) had persistent functional leg length inequality that affected factors-old age, female and soft tissue tightness due to pelvic obliquity. We believe that in most of these patients, the transient functional leg length inequality has a self-limited course, whereas in a small number, the profoud sense of inequality remains.
Arthroplasty, Replacement, Hip ; Female ; Follow-Up Studies ; Humans ; Leg Length Inequality* ; Leg* ; Pelvis ; Retrospective Studies ; Socioeconomic Factors