title: Surgical technique: Lower limb-length equalization by periosteal stripping and periosteal division.
abstract: BACKGROUND
  Stimulating growth in the shorter limb in patients with a lower limb length discrepancy (LLD) theoretically is a better alternative than retarding growth in the longer limb since it would not lead to loss of height. Periosteal stripping and/or division (PSPD) have been studied in animal models and in humans with encouraging results. We combined these procedures and used it to equalize lower limb length.
  
  
  METHODS
  The procedure consists of total circumferential stripping followed by transverse division of the periosteum at the proximal, middle, and distal shafts of the femur, tibia, and fibula of the shorter limb.
  
  
  METHODS
  We retrospectively reviewed 11 children with LLD who underwent PSPD. The average LLD was 6 ± 3.8 cm (range, 3-13 cm). The average age of the patients was 9 ± 2.5 years (range, 7-13 years). Orthoroentgenograms were obtained every 6 to 12 months after the surgery. The minimum followup was 24 months (mean, 52 months; range, 24-108 months).
  
  
  RESULTS
  Limb length equalization (LLE) was achieved in eight of 11 patients in an average of 25 ± 17.2 months (range, 12-60 months) and was maintained throughout the followup. LLE was not achieved in three children whose discrepancy was greater than 10 cm, however, PSPD helped decrease the amount of the discrepancy in all three patients. No major complications were observed in any patients.
  
  
  CONCLUSIONS
  PSPD stimulates limb length and LLE is achieved in approximately 2 years after the procedure in the majority of the patients. We believe PSPD should be considered as a surgical option for a LLD up to 6 cm.
  
  
  METHODS
  Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Rama 4 road, Pathumwan, Bangkok 10330, Thailand. Noppachart.l@chula.ac.th
authors.forename: Noppachart
authors.initials: N
authors.lastname: Limpaphayom
authors.forename: Pairatch
authors.initials: P
authors.lastname: Prasongchin
mesh_terms: D000293:Adolescent; D001852:Bone Lengthening / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007870:Leg Length Inequality / Q000601:surgery*; D035002:Lower Extremity; D008297:Male; D010521:Periosteum / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome