Limb lengthening for radiation-induced growth arrest of the pelvis and femur

Abstract

Aggressive treatment, including surgery and highdose irradiation, is essential in the treatment of softtissue tumors. However, these techniques are not without sequelae. Irradiation of bone in the developing skeleton can lead to significant limb-length discrepancy (LLD) and deformity from growth arrest. 1--3 The source of deformity and LLD may not always be unifocal or completely accounted for in the long bones. Irradiation and surgical treatment of pelvic tumors can lead to significant growth disturbances at both the proximal femur and the pelvis. 4 A scanogram or other radiographic modality that measures hip to ankle length will not accurately depict the entire LLD. Correction of deformity and LLD is paramount in these patients because it can result in gait deviation as well as degenerative changes in the joints of the lumbar spine and lower extremity. 4--6 Long-bone limblength equalization may not result in complete correction of the deformity leading to patient discomfort. Contributions of the hemipelvis to limb length must be taken into account. Complete evaluation of the lower extremity using clinical examination and full-length standing anteroposterior radiographs is necessary to fully assess deformity and appropriately plan correction. In this report, we describe the evaluation and treatment of a unique pattern of growth arrest secondary to irradiation. Each patient in this report was informed and consented to the submission of data for publication contained within this report.