A 9-year-old boy has a 3 cm post-traumatic shortening of the left femur. The right limb is normal. Skeletal age assessment predicts 4 years of growth remaining. What is the most appropriate plan?

• A Shoe raise on the right until maturity
• B Immediate limb equalisation by acute shortening of the right femur
• C Ipsilateral femoral lengthening now with an external fixator
• D Epiphysiodesis of the right distal femur, timed by growth prediction ✓

Explanation

In a growing child with a predicted discrepancy of 2 to 5 cm and sufficient remaining growth, epiphysiodesis of the longer limb, timed with Green-Anderson charts or the multiplier method, gives reliable equalisation. Ipsilateral lengthening is reserved for discrepancies greater than about 5 cm because of higher complication rates. A permanent shoe raise is the choice only for mature patients or very small residuals.

Reference: Tachdjian's Pediatric Orthopaedics, 5th ed.

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Written and medically reviewed by the StethoPrep medical team.