Limb Length Inequality

Ashok Johari
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Evaluation of Limb Length Discrepancy
The clinical examination
A thorough clinical examination is a must and this would demand a degree of expertise in evaluating the true lower limb lengths, in evaluating the role of other concomitant deformities like flexion/abduction deformity at the hip or pelvic obliquity due to other causes.

True lower limb lengths are obtained by squaring the pelvis if possible and keeping the lower limbs in identical position. Measurement of the length is taken from the anterior superior iliac spine to the knee joint line and the second from the knee to the medial malleolus indicating the tibial length.

Apparent limb lengths are measured by keeping both lower limbs parallel to each other and in the long axis of the body. It does not take any note of the position of the pelvis which will be not be square if there are hip deformities of abduction or adduction or suprapelvic contractures giving a pelvic obliquity. If these deformities are not all correctable or not to be corrected, the apparent limb length will form the basis for all calculations of the discrepancy.

In the clinical examination, it would be important to assess the status of all joints for presence of deformity, the joint range of motion & stability, the local neurovascular status and the gait of the patient. A thorough general examination is mandatory. Wooden blocks are used to level the pelvis on standing to assess the discrepancy and the raise, which may be required. An easy method of knowing what the patient will be like functionally after lengthening - temporary shoe lifts can be given and the patient assessed.

When considering enhancement of stature, it is important to measure the ratio of the upper segment to that of the lower segment, the sitting height and sub-ischial limb length as well as the upper limb lengths and their level relative to the lower limbs on standing.


References
Limb Length Inequality Limb Length Inequality 02/20/2001
<< Limb Length Inequality - Introduction Radiographic Measurement of Limb Length Discrepancy >>
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