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Limb Disorder Program

Our skilled orthopaedic specialists use the very latest techniques to help give a child with a limb defect a normal and active future. We perform limb lengthening and shortening, as well as complex limb reconstruction and amputation. Many of our treatments are done in a staged approach, to allow for a child’s continued growth.

A small difference in arm or leg length is very common, but a larger difference in length can affect mobility and quality of life. A limb length discrepancy might be caused by a previous injury to the bone or growth plate, a bone infection, a bone disease or underdeveloped bones at birth.

Congenital limb deficiencies occur when a portion or the entire upper or lower limb fails to form normally or does not form when the baby is developing in the uterus. The cause of congenital limb deficiencies is unknown, but certain risk factors that may increase the chances include genetic abnormalities and fetal exposure to chemicals, viruses, certain medications and tobacco smoke. An obstetrician can provide more information to a pregnant woman about possible risks to her baby.

Limb Length Discrepancies

Orthotics

Because the risks may outweigh the benefits, we do not usually recommend surgery to equalize leg lengths if the difference is less than 1 inch. For these small differences, we typically recommend a shoe lift.  Your child’s orthopaedic specialist can help your family with an appropriate shoe lift.

External Fixation

For young children who still have a lot of growth ahead, we use external fixation to lengthen the shorter leg. A scaffold-like frame is surgically placed on the outside of the leg and connected to the bone through small wires or pins. A small crack is made in the bone and the frame creates tension when the dial is turned. This is done several times each day. The bone may lengthen 1 millimeter per day, or about 1 inch per month. The external fixator is worn until the bone is strong enough to support the child safely, which usually takes about three months for each inch.

Expandable Rods

In adolescents, we use the new variable diameter PRECICE® Nail system to lengthen a leg. We remove a small amount of bone from the shorter leg and implant a telescopic rod. An external magnet is then placed on the skin several times a day to lengthen the rod gradually. New bone will eventually fill in the gap. The process takes about six weeks of lengthening, followed by six weeks of recovery on crutches.

Growth Restriction

In some cases when the length difference is small, your child’s doctor may recommend slowing the growth of the longer leg. This procedure involves making small incisions around the knee to stop the leg’s growth. There will not be an immediate correction in length, but the opposite limb will continue to grow and catch up over time. Our doctors have the ability to predict remaining growth so that the proper corrections are made. The goal is to reach equal length by the time growth normally ends in the mid-to-late teenage years.

Physical Therapy

Orthopedic physical therapy is critically important for children undergoing limb lengthening procedures.  When a limb is lengthened, the bone, muscles and surrounding soft tissue must lengthen with it. At CHOC Children’s, our physical therapists have special training in limb rehabilitation and know the proper techniques for ensuring a child’s recovery, as well as for preventing injuries such as fractures, nerve damage and muscle contractures.

Depending on a doctor’s orders and the patient’s needs, a physical therapy program may be as often as five times per week, for six to nine months, until a child returns to his or her normal activities. Sessions may include land therapy or pool therapy to address pain and issues such as weakness, tightness and instability. CHOC child life specialists and pet therapy volunteers may be available to help put children more at ease as they progress through their therapy program. A home exercise program is also prescribed to build on the progress made in therapy and ensure a good recovery.

 

Congenital Limb Deficiencies

There are many types of limb deficiencies, including:

•    Complete absence of the limb
•    Failure of a part of the limb to separate (commonly seen in fingers or toes)
•    Duplication (commonly seen as extra fingers or toes)
•    Overgrowth, where the limb is much larger than the normal limb
•    Undergrowth, where the limb is much smaller than the normal limb

Our overall goal when treating a congenital limb deficiency is to provide the child with a limb that has proper function and appearance.

Hand Reconstruction and Repair

As the only dedicated pediatric hand program in Orange County, we offer comprehensive treatment and rehabilitation for congenital or acquired hand conditions. We are among the world’s foremost experts in the reconstruction of children’s hand deformities, with microsurgical toe-to-hand transfers and complex microsurgical reconstruction of the forearm, wrist and hand. Learn more about our hand program.

Foot Reconstruction and Repair

CHOC Children’s has been a center for treating foot and ankle conditions for more than 30 years. Our pediatric-trained specialists have unrivaled experience in treating foot disorders in infants and children, including congenital limb defects, clubfoot, flat foot, polydactyly of toes, idiopathic toe-walking and other foot deformities. Learn more about our foot program.

Amputation and Prosthetics

Our skilled orthopaedic team does everything possible to preserve and improve a child’s limb. When a deformity is severe, we work closely and compassionately with the child and family to consider amputation (ablation). Our surgeons bring extensive experience in limb amputation, and our comprehensive rehabilitation team teaches patients how to function like any other child with the use of the very latest prosthetics. Learn more about our rehabilitation services.

Contact Us

Any procedure used to change a limb’s length or appearance is complex and often spans several years. Regular follow-up with your child’s orthopaedic doctor is very important. Our clinic will work with your family to determine the best treatment plan and coordinate every stage with you. To schedule an appointment with our orthopaedic team, please call (888) 770-2462 and press 2 for specialty care clinics.

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UC Irvine

CHOC Children's is affiliated with the UC Irvine School of Medicine