Shortening the longer leg

Shortening of the longer leg to correct limb length discrepancy may be advised when:

• the expected stature is sufficient
• lengthening of the shorter leg is contraindicated:
  • following osteomyelitis
  • in conditions of increased growth such as hemihypertrophy

In a child preventing activity at the epiphysis will arrest growth. This may be temporary, using staples across the growth plate - epiphyseodesis - or permanent, by removing a segment of diaphyseal bone, rotating it through 90 degrees, and then reinserting it.

In the adult, shortening is achieved by excising a segment of bone and then holding the approximated ends together by rigid internal fixation. A femoral osteotomy is preferred since tibial shortening is both more complicated and the end result often displeasing cosmetically. Up to 7.5 cm may be removed without causing permanent loss of function.

Shortening by these techniques however, may be contraindicated if the resultant final stature of the patient would be unacceptable. Also, one must consider that often the longer leg is the normal one and surgery may jeopardise it.