Module 31, Pediatric Orthopaedist Level

1,2,3,4,5

This 3 year boy presented with shortening of the right humerus. Clinical examination revealed 4 cm shortening of right arm and painless limitation of ROM of right shoulder; abduction was 150 degrees with 80 degrees at the glenohumeral joint and internal rotation was significantly limited(image 1). There was also a 1 cm shortening of the right leg and a 10 degree valgus deformity of the same knee(image 2). Radiological examination showed absence of proximal epiphysis of the right humerus(image 1)with marked deformity of the metaphyseal region. By age 11 the child had a good gait pattern however the upper extremity length discrepancy was becoming a cosmetic and functional concern. X-rays at age 11 show significant angulation developed in the humerus(image 3,4 & 5). However tibial growth was good.

Question 31A

This is the most appropriate time (11 years old) to consider lengthening and the Ilizarov frame is the most appropriate approach.

Question 31B

The radial nerve should be exposed prior to pin placement.

Question 31C

Lengthening should be at a rate of 1 mm per day.

Question 31D

Lengthening this child should be similar to lengthening a congenitally short humerus.

Question 31E

The maximum amount of length one should expect to obtain is 80% of the length of the humerus.