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Conditions treated at Limb Reconstruction and Lengthening Center

Conditions treated at Limb Reconstruction and Lengthening Center

Patient at the Limb Reconstruction & Lengthening Center

The Center for Advanced Pediatric Limb Reconstruction and Lengthening at Shriners Hospitals for Children — St. Louis provides the best in pediatric orthopaedic evaluation, diagnosis and surgical intervention for children with limb differences and deformities. Through the collaboration of our staff, including advanced nursing care, therapy and psychological intervention, our goal is to improve the function, mobility and independence of each child.

Conditions treated include:

ROTATIONAL PROBLEMS

Femoral anteversion

An inward twist of the femur (thigh bone) that leads to children walking with their feet turned inward. Typically everyone is born with femoral anteversion. Many children grow out of this by 2 years of age, but many children continue to intoe. Often this worsens slightly from age 2–5. Nearly all children grow out of this by age 9–10. There is no treatment that will make children grow out of this more quickly or will affect whether or not children will grow out of this. This can occur in children who are otherwise completely healthy or in children who have neuromuscular conditions such as cerebral palsy. After age 9–10, children who are symptomatic with tripping and gait problems that are functionally limiting, can be treated by derotational osteotomies (cutting the bone and untwisting it). The technique most commonly used at the St. Louis Shriners Hospital involves cutting the bone and placing a rod inside the femur to allow the bone to heal.

Femoral retroversion

An outward twist of the femur (thigh bone) that leads to children walking with their feet turned outward. This can be associated with hip conditions such as slipped capital femoral epiphysis or congenital coxa vara. After age 9–10, children who are symptomatic with tripping and gait problems that are functionally limiting, can be treated by derotational osteotomies (cutting the bone and untwisting it). The technique used to correct this condition can involve a rod, as in femoral anteversion, but depends on the cause of the retroversion.

Tibial torsion (internal)

An inward twist of the tibia (larger bone in the lower leg) that leads to children walking with their feet turned inward. Many children have internal tibial torsion when they first begin walking. Many children grow out of this by 3 years of age, but some children continue to have an inward twist. This inward twist can improve until around age 6–7. After age 6–7, children who continue to have internal tibial torsion can develop tripping and gait abnormalities. Children who are symptomatic with gait problems or knee pain that is functionally limiting can be treated by derotational osteotomies (cutting the bone and untwisting it). The technique most commonly used at the St. Louis Shriners Hospital involves cutting the tibia, untwisting it, and placing a plate on the bone to allow the bone to heal.

Tibial torsion (external)

An outward twist of the tibia (larger bone in the lower leg) that leads to children walking with their feet turned outward. Many children have internal tibial torsion when they first begin walking. Many children grow out of this by 3 years of age, but some children develop an outward twist. This outward twist can improve until around age 6–7. After age 6–7, children who continue to have external tibial torsion can develop knee pain and this can produce gait abnormalities. Children who are symptomatic with gait problems or knee pain that is functionally limiting can be treated by derotational osteotomies (cutting the bone and untwisting it). The technique most commonly used at the St. Louis Shriners Hospital involves cutting the tibia, untwisting it and placing a plate on the bone to allow the bone to heal.

ANGULATORY PROBLEMS

Genu valgum (knock knees)

A condition where the knees bow inward leading to the child being unable to stand with the ankles touching without pushing the knees together. Children are normally born with bowed legs (genu varum). The legs begin to straighten around age 8 months and eventually become straight between age 18 and 30 months. The legs then develop knock knees (genu valgum) that will increase until it reaches a peak at around age 5 years. The legs then straighten out by around age 8–9. Children who have genu valgum have an increased likelihood of knee pain.

Genu varum (bowed Legs)

A condition where the knees bow outward leading to the child being unable to stand with the knees touching without pushing the ankles together. Children are normally born with bowed legs (genu varum). The legs begin to straighten around age 8 months and eventually become straight between age 18 and 30 months. The legs then develop knock knees (genu valgum) that will increase until it reaches a peak at around age 5 years. The legs then straighten out by around age 8–9. Children who have genu varum can have knee pain.

Tibia vara (Blount's disease)

A problem with the growth plates around the knee that causes bowing of the lower extremities. This can occur in children under 3 years of age and is known as infantile tibia vara (infantile Blount's disease), in children age 3–7, known as juvenile tibia vara (juvenile Blount's disease), or in children over age 7, known as adolescent tibia vara (adolescent Blount's disease).

Physeal arrest

A problem caused by an injury to the growth plate leading to a permanent lack of growth of part or all of the growth plate. This injury can be caused by a fracture, infection, tumor, cyst or other problems. This can lead to an angulatory deformity or shortening of a limb.

METABOLIC BONE DISEASE

Rickets

A problem that affects the way the body processes calcium, and in particular, the way the body incorporates calcium into the bones. Rickets can be caused by dietary deficiencies, kidney problems or genetic metabolic issues. Children with dietary rickets have too little calcium in their diet. Kidney conditions can cause problems with how the body processes calcium and phosphorus, leading to inadequate calcium being deposited in the child’s bone. Children with genetic rickets have metabolic problems that affect how the child’s body absorbs calcium and moves the calcium into the bone. Children with rickets have weak bones that are less dense than they should be and often have characteristic widening of the growth plates that can lead to changes in alignment of the lower extremities. Treatment includes medical care and potentially, surgical care. The metabolic research unit at the St. Louis Shriners Hospital specializes in the medical care of patients with genetic rickets.

Osteogenesis imperfecta (brittle bone disease)

A problem that causes children’s bones to fracture or break easily, often after minimal injuries. There are many types of osteogenesis imperfecta with different effects on the child’s bones and varying degrees of fragility. Some lead to a few fractures during childhood while others can cause dozens of fractures. Some of these can cause problems with the child’s teeth as well.

Congenital pseudarthrosis of the tibia

A problem with the tibia (larger bone in the lower leg) that causes it to break or fracture easily, often in infancy, and often does not heal. This leads to a pseudarthrosis or nonunion, in which the bone does not heal at all or heals only with fibrous tissue. Children with congenital pseudarthrosis often have bowing of the tibia and fibula (smaller bone in the lower leg) in an anterolateral (front and side) direction in which the bow is directed forward and outward. About half of children with congenital pseudarthrosis of the tibia have neurofibromatosis.

LIMB LENGTH DISCREPANCY

Physeal arrest

A problem caused by an injury to the growth plate leading to a permanent lack of growth of part or all of the growth plate. This injury can be caused by a fracture, infection, tumor, cyst or other problems. This can lead to an angulatory deformity or shortening of a limb.

Acquired limb length discrepancy (LLD)

Unequal limb lengths resulting from one limb growing more slowly or more quickly than the other because of a problem that originates or continues after birth. This can be commonly due to trauma, infection, tumor, metabolic or developmental problems.

Congenital limb length discrepancy

Unequal limb lengths that result from a condition existing prior to birth leading to a limb being too long or too short.

Congenital short femur

A form of congenital limb length discrepancy in which the thigh and tissues around the femur (thigh bone), and the tissue around it, are shorter than normal. This is commonly associated with other conditions, including a shallow hip (acetabular dysplasia), external rotation, proximal femoral deformity and knock knee. Children with this condition often have fibular (fibula – smaller bone in the lower leg) hemimelia as well.

Proximal femoral focal deficiency

A form of congenital limb length discrepancy in which the thigh and tissues around the femur (thigh bone), and the tissue around it, are shorter than normal. This is typically more severe than congenital short femur and is commonly associated with other conditions, including a shallow hip (acetabular dysplasia), external rotation, proximal femoral deformity and knock knee. Children with this condition often have fibular (fibula – smaller bone in the lower leg) hemimelia as well. The disorder may affect one side or both.

Tibial hemimelia

A rare congenital limb length discrepancy affecting the lower leg. The tibia (larger bone in the lower leg) is primarily affected, leading to failure of all or part of the bone to form. The leg typically is shorter and may be associated with an abnormal knee or ankle. There may be a clubfoot present and the child may be missing toes or have too many toes.

Fibular hemimelia

A congenital limb length discrepancy affecting the lower leg. The fibula (smaller bone in the lower leg) is primarily affected leading to failure of all or part of the bone to form. The leg typically is shorter and may be associated with an abnormal knee or ankle. There may be a fusion or coalition present in the foot and the child may be missing toes.

Posteromedial bowing of the tibia

A congenital limb length discrepancy affecting the lower leg. The tibia (larger bone in the lower leg) and the fibula (smaller bone in the lower leg) are both affected, leading to angulation of the lower leg with the ankle tilted outward and forward (valgus and recurvatum). The leg typically is shorter and often the angulation spontaneously resolves over the first five to eight years of life. The child is often born with a calcaneo-valgus foot deformity. This deformity typically resolves by 18 months of age with gentle stretching. Casting or bracing is almost never required.

Hemihypertrophy

A congenital limb length discrepancy in which the affected side of the body is larger than it should be. The limbs will typically be larger in diameter as well as longer. This is associated in a small number of patients with retroperitoneal and abdominal tumors. Ultrasounds and blood tests are typically ordered in infancy and early childhood to make sure that the child does not have one of these tumors.

Other conditions treated

  • Skeletal dysplasia
  • Metaphyseal dysplasia
  • Epiphyseal dysplasia
  • Achondroplasia
  • Dysplasia epiphysealis hemimelica (Trevor's Disease)
  • Osteochondromatosis (multiple hereditary exostoses - MHE)