A 14-year-old boy has a 5 cm leg-length discrepancy due to physeal arrest after a childhood tibial fracture. The contralateral limb is normal. The MOST appropriate strategy when predicted adult LLD is confirmed to be 5 cm is:

• A Contralateral epiphysiodesis (timed to skeletal maturity)
• B Shoe raise of 5 cm permanently
• C Femoral shortening osteotomy on the longer side
• D Tibial lengthening of the shorter limb by distraction osteogenesis ✓

Explanation

Limb lengthening by distraction osteogenesis (Ilizarov or monolateral fixator) is appropriate for LLD of 4–6 cm in skeletally immature or mature patients when the shorter limb needs to be corrected. At 5 cm, lengthening preserves final adult height, which would be compromised by shortening (C) or epiphysiodesis (A) on the longer limb. Epiphysiodesis (A) is ideal for LLD of 2–4 cm when performed at the appropriate timing (Moseley chart). Shoe raise >2–3 cm is impractical and biomechanically undesirable long-term.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.