Displaying all 12 publications

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  1. Devnani AS
    Singapore Med J, 2000 Nov;41(11):534-7.
    PMID: 11284611
    To describe an appliance used for equalisation of severe congenital lower limb length discrepancy for patients who refuse to undergo any operative correction but wish to walk and look better.
    Matched MeSH terms: Leg Length Inequality/congenital*; Leg Length Inequality/physiopathology; Leg Length Inequality/psychology; Leg Length Inequality/rehabilitation*
  2. Singh VA, Ramalingam S, Haseeb A, Yasin NFB
    J Orthop Surg (Hong Kong), 2020 7 23;28(2):2309499020941659.
    PMID: 32696708 DOI: 10.1177/2309499020941659
    INTRODUCTION: Limb length discrepancy (LLD) of lower extremities is underdiagnosed due to compensatory mechanisms during locomotion. The natural course of compensation leads to biomechanical alteration in human musculoskeletal system leading to adverse effects. General consensus accepts LLD more than 2 cm as significant to cause biomechanical alteration. No studies were conducted correlating height and lower extremities true length (TL) to signify LLD. Examining significant LLD in relation to height and TL using dynamic gait analysis with primary focus on kinematics and secondary focus on kinetics would provide an objective evaluation method.

    METHODOLOGY: Forty participants with no evidence of LLD were recruited. Height and TL were measured. Reflective markers were attached at specific points in lower extremity and subjects walked in gait lab at a self-selected normal walking pace with artificial LLDs of 0, 1, 2, 3, and 4 cm simulated using shoe raise. Accommodation period of 30 min was given. Infrared cameras were used to capture the motion. Primary kinematic (knee flexion and pelvic obliquity (PO)) and secondary kinetic (ground reaction force (GRF)) were measured at right heel strike and left heel strike. Functional adaptation was analyzed and the postulated predictor indices (PIs) were used as a screening tool using height, LLD, and TL to notify significance.

    RESULTS: There was a significant knee flexion component seen in height category of less than 170 cm. There was significant difference between LLD 3 cm and 4 cm. No significant changes were seen in PO and GRF. PIs of LLD/height and LLD/TL were analyzed using receiver operating characteristic curve. LLD/height as a PI with value of 1.75 was determined with specificity of 80% and sensitivity of 76%.

    CONCLUSION: A height of less than 170 cm has significant changes in relation to LLD. PI using LLD/height appears to be a promising tool to identify patients at risk.

    Matched MeSH terms: Leg Length Inequality/diagnosis*; Leg Length Inequality/physiopathology
  3. Singh, H.
    MyJurnal
    Clubfoot is associated with leg length inequality, with the affected leg being shorter as a consequence of the hypoplasia. Early treatment of a minimally hypoplastic clubfoot usually allows catchup growth and both legs equalise in length after a few years. Late treatment however is associated with a shortening of the affected foot. A case is described where late treatment of a severe clubfoot is assocated with lengthening of the affected leg.
    Matched MeSH terms: Leg Length Inequality
  4. Sulaiman AR, Munajat I, Liau KM, Salehuddin AY, Shukrimi A
    Med J Malaysia, 2006 Dec;61 Suppl B:48-50.
    PMID: 17600992
    Distraction osteogeneis over intramedullary nail has a benefit of decreasing the time for external fixation thus reducing the rate of associated complications. However, risk of panosteomyelitis is still the major worry. We are reporting two patients who underwent the procedure. The first case was a 13-year-old girl requiring 6 cm of femoral lengthening and the second case was a 17-year-old girl who required 5 cm of tibial lengthening. The healing index was 19.5 days/cm and 14.8 days/cm respectively, compared favorably to 30 days/cm with traditional method of distraction osteogenesis. There were mild pin tract infections and joint stiffness which responded to non-operative treatment.
    Matched MeSH terms: Leg Length Inequality/radiography; Leg Length Inequality/surgery*
  5. Jamaluddin S, Sulaiman AR, Imran MK, Juhara H, Ezane MA, Nordin S
    Singapore Med J, 2011 Sep;52(9):681-4.
    PMID: 21947147
    The aim of this study was to determine the reliability and accuracy of the tape measurement method (TMM) with a nearest reading of 5 mm in assessing leg length discrepancy (LLD).
    Matched MeSH terms: Leg Length Inequality/diagnosis; Leg Length Inequality/radiography*
  6. Azizan NA, Basaruddin KS, Salleh AF
    Appl Bionics Biomech, 2018;2018:5156348.
    PMID: 30116295 DOI: 10.1155/2018/5156348
    Various studies have examined body posture stability, including postural sway and associated biomechanical parameters, to assess the severity effects of leg length discrepancy (LLD). However, various viewpoints have been articulated on the results of these studies because of certain drawbacks in the comprehensive analysis of the effect of variations in LLD magnitude. Therefore, this systematic review was performed to help focus on the current findings to help identify which biomechanical parameters are most relevant, commonly used, and able to distinguish and/or have specific clinical relevance to the effect of variations in LLD magnitude during static (standing) and dynamic (walking) conditions. Several electronic databases containing studies from the year 1983 to 2016 (Scopus, ScienceDirect, PubMed, PMC, and ProQuest) were obtained in our literature search. The search process yielded 22 published articles that fulfilled our criteria. We found most of the published data that we analyzed to be inconsistent, and very little data was obtained on the correlation between LLD severity and changes in body posture stability during standing and walking. However, the results of the present review study are in line with previous observational studies, which describe asymmetry in the lower limbs corresponding to biomechanical parameters such as gait kinematics, kinetics, and other parameters described during static (standing) postural balance. In future investigations, we believe that it might be useful to use and exploit other balance-related factors that may potentially influence body posture stability.
    Matched MeSH terms: Leg Length Inequality
  7. Kadir KH, Abdul Rashid AH, Das S, Ibrahim S
    J Foot Ankle Surg, 2011 Mar-Apr;50(2):252-6.
    PMID: 21354013 DOI: 10.1053/j.jfas.2010.10.017
    Diplopodia is a rare congenital disorder that has not been extensively discussed in textbooks, and case reports appear to be the main source of information. Although the exact cause of diplopodia remains unknown, the presence of extra digits as well as metatarsals and tarsals allows it to be differentiated from pedal polydactyly. Syndactyly refers to the congenital fusion of the digits. Concomitant bilateral syndactyly and diplopodia is extremely unusual, and in this report we describe a case of right diplopodia and left polydactyly combined with bilateral manual syndactyly in a 15-year-old girl who was ultimately treated with through-the-knee amputation. Radiological examination of the right leg revealed tibial hypoplasia and the right foot displayed 8 digits with corresponding metatarsals and tarsals, whereas the left leg revealed 2 extra digits on the medial aspect of the foot with corresponding metatarsal and tarsal bones. Anatomical dissection of the right foot revealed that it was divided into halves consisting of 8 toes with corresponding metatarsals and tarsals, as well as tibial hypoplasia and absence of the great toe. Diplopodia associated with tibial hypoplasia and syndactyly can be treated surgically, and the present case report details the clinical, radiological, and anatomical elements of this rare deformity.
    Matched MeSH terms: Leg Length Inequality/etiology
  8. Fazreena Othman N, Salleh Basaruddin K, Hanafi Mat Som M, Shukry Abdul Majid M, Razak Sulaiman A
    Acta Bioeng Biomech, 2019;21(1):55-62.
    PMID: 31197285
    PURPOSE: The aim of this study was to examine the joint contact forces (JCF) between each limb as the LLD magnitude increases during walking activity.

    METHODS: Eighteen male healthy subjects volunteered to participate in the experiment. Walking gait analysis was conducted with eight different levels of insole to simulate the LLD, starting from 0 cm until 4.0 cm with 0.5 cm increment. Qualisys Track Manager System and C-motion Visual 3D biomechanical tools were used to analyse the results. Four joints (ankle, knee, hip, and pelvis) of lower limb of two legs were investigated. The increment of insoles was placed on the right leg to represent the long leg.

    RESULTS: The results suggest that the mean contact forces for all joints in the short leg were increased as the increment level increased. On the contrary, the mean contact forces in the long leg decreased when the LLD level increased. Among these four joints, JCF in hip shows a positive increment based on the ASI value. Means that hip shows the most affected joint as the LLD level increase.

    CONCLUSIONS: The result obtained in this study might help clinicians treat patients with a structural LLD for treatment plan including surgical intervention.

    Matched MeSH terms: Leg Length Inequality/physiopathology*
  9. Nordin S, Ros MD, Faisham WI
    Singapore Med J, 2001 Dec;42(12):563-5.
    PMID: 11989577
    We have studied residual limb length inequality following femoral shaft fractures in 62 children. From 61.2% of the children who had shortening of more than 1 cm at union, 34.21% still maintained the shortening at the completion of study. The longitudinal femoral overgrowth occurred significantly during the first 18 months of the fracture in 77.4% of the children, with an average of 1.17 cm. Children with proximal-third fractures and those who sustained the fractures before eight years of age have higher capability to correct the limb length disparity.
    Matched MeSH terms: Leg Length Inequality/etiology*
  10. Azizan NA, Basaruddin KS, Salleh AF, Sulaiman AR, Safar MJA, Rusli WMR
    J Healthc Eng, 2018;2018:7815451.
    PMID: 29983905 DOI: 10.1155/2018/7815451
    Balance in the human body's movement is generally associated with different synergistic pathologies. The trunk is supported by one's leg most of the time when walking. A person with poor balance may face limitation when performing their physical activities on a daily basis, and they may be more prone to having risk of fall. The ground reaction forces (GRFs), centre of pressure (COP), and centre of mass (COM) in quite standing posture were often measured for the evaluation of balance. Currently, there is still no experimental evidence or study on leg length discrepancy (LLD) during walking. Analysis of the stability parameters is more representative of the functional activity undergone by the person who has a LLD. Therefore, this study hopes to shed new light on the effects of LLD on the dynamic stability associated with VGRF, COP, and COM during walking. Eighteen healthy subjects were selected among the university population with normal BMIs. Each subject was asked to walk with 1.0 to 2.0 ms-1 of walking speed for three to five trials each. Insoles of 0.5 cm thickness were added, and the thickness of the insoles was subsequently raised until 4 cm and placed under the right foot as we simulated LLD. The captured data obtained from a force plate and motion analysis present Peak VGRF (single-leg stance) and WD (double-leg stance) that showed more forces exerted on the short leg rather than long leg. Obviously, changes occurred on the displacement of COM trajectories in the ML and vertical directions as LLD increased at the whole gait cycle. Displacement of COP trajectories demonstrated that more distribution was on the short leg rather than on the long leg. The root mean square (RMS) of COP-COM distance showed, obviously, changes only in ML direction with the value at 3 cm and 3.5 cm. The cutoff value via receiver operating characteristic (ROC) indicates the significant differences starting at the level 2.5 cm up to 4 cm in long and short legs for both AP and ML directions. The present study performed included all the proposed parameters on the effect of dynamic stability on LLD during walking and thus helps to determine and evaluate the balance pattern.
    Matched MeSH terms: Leg Length Inequality/physiopathology*
  11. Al-Chalabi MMM, Wan Sulaiman WA
    Cureus, 2021 Jan 21;13(1):e12834.
    PMID: 33633877 DOI: 10.7759/cureus.12834
    Tibial hemimelia is a relatively rare congenital tibial longitudinal deficiency (approximately 1 per 1 million live births), unilateral or bilateral, with a relatively intact fibula. Hemimelia results from a disruption of the lower limb developmental field during embryogenesis due to slow or even abort of chondrification process, which results in leg length discrepancy. Affected leg commonly appears short and deformed with knee, ankle, and foot involvement. It may present with a variety of associated anomalies. Surgical treatment varies according to the type and degree of deformity, and reconstructive interventions are still limited. Reported cases of tibial hemimelia are very infrequent, especially tibial hemimelia in twins. Usually, the cases were in single embryo or less frequently in one of the monozygotic twins, but no reported cases regarding tibial hemimelia in one of the dizygotic twins as this article reports.
    Matched MeSH terms: Leg Length Inequality
  12. Kwan MK, Penafort R, Saw A
    Med J Malaysia, 2004 Dec;59 Suppl F:39-41.
    PMID: 15941159
    Joint stiffness is one of the complications of limb procedure. It developes as a result of failure of knee flexors to lengthen in tandem with the bone, especially when there is inadequate physical therapy to provide active and passive mobilization of the affected joint. We are reporting four patients who developed fixed flexion contracture of their knees during bone lengthening procedure for the tibia with Ilizarov external fixator. Three of them were treated for congenital pseudoarthrosis and one was for fibular hemimelia. None of them were able to visit the physiotherapist even on a weekly basis. A splint was constructed from components of Ilizarov external fixator and applied on to the existing frame to passively extend the affected knee. Patients and their family members were taught to perform this exercise regularly and eventually near complete correction were achieved. With this result, we would like to recommend the use of this "Passive Knee Extension Splint" to avoid knee flexion Contracture during limb lengthening procedures with Ilizarov external fixators.
    Matched MeSH terms: Leg Length Inequality/surgery
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