What is limb deformity?
Limb deformity is malalignment, shortening or bowing of the long bones in the lower or upper extremities.
Limb deformity may be:
- Congenital: Deformity due to altered development in utero
- Developmental: Due to altered growth after birth
- Acquired: Secondary to injury, infection or tumors
What are the common forms of limb deformity?
Common congenital limb deformities includes:
- Club Foot Deformity: Complex foot deformity associated with the foot turned downward, inward and rotated to face the opposite limb
- Congenital Vertical Talus: A foot deformity associated with rocker bottom foot deformity
- Congenital focal femoral deficiency: Shortening or absence of the thigh bone and hip joint in newborns
Common Developmental forms of limb deformity include:
- Bow leg deformity: Usually considered abnormal in children older than 2 years of age
- Knock knee deformity: Usually considered abnormal in children past their fifth birthday
- Blount’s disease: A specific form of bowing of the legs caused by growth plate abnormalities
- Acquired limb deformity: can occur acutely after fracture healing in an abnormal, uncorrected position or gradually over time from a partial or complete injury to a growth plate. This can affect any of the long bones in the upper or lower extremity.
What is limb deformity correction?
Limb deformity correction is the process of restoring the alignment and function of the extremity through bracing, surgery with or without therapy.
Indications:
- Limb length discrepancy
- Malalignment resulting in pain and limitation of activities
- To prevent future joint deterioration
- To improve functional level
How is limb deformity correction surgery performed?
Growth Modulation: Children are unique compared to adults in having open growth plates. With careful planning, we can preferentially slow down growth plates to gradually correct deformity. For bow leg deformity or severe knock knee deformity, this requires slowing of the growth plates on one side with specialized tethering plates.
In other instances the entire growth plate is shut down to allow the opposite shorter limb to catch up.
Osteotomy and acute or gradual correction:
Sometimes the amount of deformity is too big to be corrected with the amount of growth remaining. In these instances, carefully timed surgery to cut the bone and realign it either in one setting or over several weeks is performed.
- Acute correction with internal fixation: When the deformity and anatomy allow, the deformity is corrected in one setting and the cut bone is held in the corrected position with plates and screws.
- Gradual Correction with an external fixator: If the deformity is complex or the anatomy does not allow an acute correction, the bone is cut and an external fixator is applied that allows gradual correction of the deformity over several weeks.
- Bone lengthening: When the leg length discrepancy is too large, this requires lengthening of the shorter bone. This is done with internal lengthening nails that are controlled with external magnets that allow gradual lengthening of the bones. This is a painless process and allows patients and their families to participate in restoring the limb length.
What to expect after surgery:
Recovery includes regular follow ups to confirm good healing. Bracing and therapy are used to help with the recovery. Once function and alignment has been restored, patients are cleared to go back to regular activities. Depending on the complexity of the deformity and duration of correction, this may take several months.