Can a prosthesis solve the problem? – WWN

Can a prosthesis solve the problem? – WWN


Of Cesare Faldini

If the difference is between one and two centimeters, it must be evaluated on a case-by-case basis: the pelvis can function as a barbell, compensating for the discrepancy, especially if this occurred in childhood or slowly during growth.

Are there prostheses capable of rebalancing, especially for physical activity, the length of my legs which in my case have different measurements, even if only for a few millimetres?

He replies Cesare Faldini, director of the First Orthopedic Clinic, Rizzoli Institute; full professor at the University of Bologna (GO TO THE FORUM)

The different length of the legs is defined dysmetria or heterometria. If less than one centimeter, it is so frequent that it can be considered a variant of normality: in fact the pelvis, to which the legs are attached, can act as a balance by tilting slightly towards the shorter limb without any functional consequence, as the spine compensates with a slight curve which has nothing to do with scoliosis. For this reason it is inadvisable to correct discrepancies of millimetres: they are irrelevant, the organism is adaptable and almost everyone has them. If the length difference between one and two centimeters must be evaluated on a case-by-case basis: the pelvis can still function as a balance wheel, compensating for the discrepancy, especially if this occurred in childhood or slowly during growth.

Rise in the shoe

In a patient who developed it suddenly (following a fracture or prosthetic surgery), it can be compensated with a simple cork insole of suitable thickness inside the shoe (be careful of the silicone heel cups, they crush). We tend to correct 0.5-1 cm less than the defect, so as to still take advantage of the rocker effect of the pelvis, avoiding unnecessary bulk in the shoes. Discrepancy greater than two centimeters must be corrected with a riseotherwise the excessive inclination of the pelvis causes the spine to be overloaded with a large compensation curve. The internal footbed can reach approximately 1.5 centimetersIf that’s not enough, it can be integrated with an external heel to glue onto the sole.

Surgery


If the discrepancy requires an unacceptable increase, it is possible to think about a surgical solution: the long limb is shortened by removing a small cylinder of bone from the femur or tibia and performing a fixation, or the short limb is lengthened with the external fixator or with a magnetic intramedullary nail: after having sectioned the bone in the operating room, the two fragments are moved apart very slowly (approximately 1 mm per day) from the external fixator or magnetic nail, until the desired growth is achieved. In this way significant discrepancies are recovered (greater than 10 cm)but treatments can last from 6-8 months to over a year, depending on the extent of the lengthening.

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December 30, 2023 (changed December 30, 2023 | 07:53)



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