Does leg lengthening pose a threat to a child's mental health?: An interim report one year after surgery.
Previous studies suggest that children react with functional and psychological disturbances after leg lengthening (LL). Long-term effects are not known, and there is a lack of prospective studies. The aim of this interim prospective study was to investigate the psychological impact of the Ilizarov technique on a sample of children 1 year after surgery.


METHODS
: The subjects were 27 patients aged 6 to 16 years treated using the Ilizarov technique at the Pediatric Orthopaedic Department, Uppsala University Hospital, between 1997 and 2005. A control group of healthy children matched for age and sex were also included.Semistructured interviews and psychometric measures (anxiety, depression, self-esteem, behavior) were administered to patients and parents before surgery and 1 year after. Psychological measures were correlated with medical records (days of hospitalization, gained length, etc). The control group was examined at initial assessment only.


RESULTS
: Before reconstructive surgery, the LL group had a significantly lower self-esteem compared with the control group. Aggressive behavior, attention and externalization problems, anxiety, and depression were significantly reduced after LL. Parents' state anxiety was also reduced. There were no differences in trait anxiety between the parents of patients and the parents of the control children.


CONCLUSIONS
: Patients reported pain, psychological discomfort, complications, and restrained function during LL. However, there were no adverse psychological effects at 1-year follow-up; rather, there were signs of improved mental health. No single psychological parameter could predict the outcome after LL.
Niemelä
Birgitta Johansson
BJ
Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Sweden. birgitta.johansson.niemela@akademiska.se
Tjernström
Björn
B
Andersson
Gerhard
G
Wahlsten
Viveka Sundelin
VS
D000293:Adolescent; D002648:Child; D003625:Data Collection; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018889:Ilizarov Technique / Q000009:adverse effects / Q000523:psychology*; D007870:Leg Length Inequality / Q000523:psychology / Q000601:surgery*; D008297:Male; D008603:Mental Health; D010146:Pain / Q000209:etiology; D010290:Parents / Q000523:psychology; D011446:Prospective Studies; D011594:Psychometrics; D012649:Self Concept