What is the management for a patient with a 15mm left lower limb length discrepancy and mild genu varum deformity, indicated for tibial lengthening?

From the Guidelines

Tibial lengthening is recommended for the patient with a 15mm left lower limb length discrepancy and mild genu varum deformity, with the procedure involving an osteotomy of the right tibia followed by gradual distraction using an external fixator device or internal lengthening nail. The goal of this procedure is to address both the limb length discrepancy and help balance the patient's gait, potentially improving the genu varum deformity by enhancing overall limb alignment [ 1 ]. Key considerations for the management of this patient include:

• The importance of weight-bearing exercise and maintenance of joint range to maximize strength and endurance [ 1 ]
• The role of physiotherapy following surgery to address any decreased range of movement, muscle weakness, fatigue, instability, or physical deconditioning [ 1 ]
• The need for elective surgical treatment to be performed only after medical treatment has been maximized for at least 12 months [ 1 ]
• The preference for surgery to be performed by a surgeon with expertise in metabolic bone diseases [ 1 ]
• The consideration of the patient's age in the decision-making process, with guided growth techniques potentially being more suitable for younger patients [ 1 ] The procedure should be carefully planned and monitored, with regular clinical and functional assessments, including radiography, to ensure optimal outcomes and minimize complications [ 1 ].

From the Research

Management of 15mm Left Lower Limb Length Discrepancy and Mild Genu Varum Deformity

• The management of a patient with a 15mm left lower limb length discrepancy and mild genu varum deformity, indicated for tibial lengthening, involves various surgical options, including gradual correction using external fixation or motorized internal lengthening 2.
• Acute correction of multiplanar proximal tibial deformity utilizing fixator-assisted intramedullary nailing is a novel procedure that can be used to treat adolescent Blount disease deformity in skeletally mature individuals 3.
• The procedure involves the use of external fixators to hold the bone deformity in the corrected alignment, followed by the placement of an intramedullary nail to secure the correction 3.
• Alternative operative treatments include external fixation and gradual or acute deformity correction, as well as fixator-assisted acute deformity correction and plate fixation 3.
• The choice of treatment depends on the severity of the deformity, the presence of limb shortening, and the patient's overall condition 2, 4.

Considerations for Treatment

• Careful preoperative planning is essential to accurately correct the anatomic and mechanical axes in all planes 3.
• Prophylactic nerve decompression should be considered in cases of acute correction of severe bone deformities 3.
• The use of a tourniquet should be avoided whenever possible to minimize tissue trauma, postoperative swelling, and the need for prophylactic fasciotomies 3.
• Temporary uniplanar external fixators can be used to obtain and hold perfect osseous alignment prior to placing any definitive hardware 3.

Outcomes and Complications

• The expected outcome of treatment is complete bone deformity correction and healing of the osteotomy site(s) 3.
• Complications such as equinus deformity and varus recurrence can occur, especially in patients with skeletal dysplasia 5.
• Equinus deformity can be easily corrected, but varus recurrence requires careful evaluation and treatment of intrinsic and extrinsic factors 5.