Dysmetries

"The most commonly treated dysmetries are those of the lower extremities, due to their repercussion on walking and the corresponding functional alteration".

DR. MATÍAS ALFONSO
CODIRECTOR. ORTHOPEDIC SURGERY AND TRAUMATOLOGY DEPARTMENT

Bone dysmetry is the discrepancy in the length of the extremities, either by excess (hypermetry) or by default (hypometry).

Limb dysmetry is a frequent reason for consultation in children's orthopedics.

The longitudinal growth of the bone is related to the growth cartilages (physis). Each physis has its own potential for growth and in relation to bone age.

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What are the symptoms of dysmetry?

The main clinic of lower limb discrepancies results in a gait disturbance, in addition to the aesthetic repercussion.

In these patients, an irregular and unstable gait is produced.

The compensation of an unstable gait is produced by the inclination of the pelvis towards the side of the short extremity and deviation of the spine in the opposite direction.

On the other hand, it is generally accepted that dysmetries greater than 2.5 cm. in adulthood can produce low back pain and scoliotic attitude.

The most common symptoms are:

  • Alteration of the march.
  • Discomfort when walking.
  • Scoliotic posture (deviated to one side).

Do you have any of these symptoms?

You may have a dysmetry

How is dysmetry diagnosed?

In congenital causes, the diagnosis is usually early by intrauterine manifestations assessed by ultrasound methods. It is recommended to perform the general examination with the patient in underwear, in order to assess skin aspects, length of upper limbs, facial symmetry, etc.

At early ages (especially the first year of life), the examination of the hip is of vital importance for the evaluation of dysplastic phenomena.

For this reason, it is advisable to have a simple radiological examination in the anteroposterior projection of the pelvis.

The CT scan is the most accurate method, since it allows the assessment of the axes, without magnification. Based on these techniques, and especially through conventional radiology, limb alignment exams can be performed.

These studies will allow us to define the type of deformity, locate and measure as accurately as possible the axial deviations of each segment and compare them with ranges of normality. In addition, they will allow us to measure the dysmetry radiologically, as well as to plan possible correction methods.

How is dysmetry treated?

Usually the type of treatment is chosen according to the magnitude of the discrepancy.

Dysmetries of less than 1 cm are usually well tolerated and only require periodic controls in stages of growth.

  • Differences between 1-3 cm. are tributary of compensatory rises.
  • Dysmetries greater than 3 cm. are usually treated with surgical methods: Patients with a prognosis of dysmetry between 3 and 7 cm. can be treated with epiphysiodesis, or with lengthening techniques, while those predicted to have dysmetry greater than 7 cm. are usually treated by lengthening, in one or more surgical times.
  • In cases of severe deformities, with a prognosis of severe dysmetry, amputation should be considered as a valid option for rapid adaptation of the patient to the prosthetic material.

Bone lengthening is usually indicated when the discrepancy of the extremities exceeds 3 cm. or when the dysmetry is lower in patients with high functional demand.

Patients with severe congenital deficiencies are not ideal candidates for lengthening, and the extension prosthesis should be assessed.

The objectives of lengthening are summarized in obtaining the maximum correction with the least number of interventions, as well as minimizing the use of lift during growth.

In the case of infantile dysmetries, the goal of reaching the end of growth with complete correction is added. Bone elongation only makes sense at early ages when bones are immature and the possibility of growing a few centimeters is relatively easy. Once growth is complete, it is not advisable to do elongation.

In adults it is much more complicated and probably has no indication since the risks are very high and surgeries can be multiple. The essential difference is not so much the bone but the soft tissues that must also be stretched and that in an adult are not elastic.

The procedure is performed with a device called an external fixator, which is placed on the outside and goes to the bone, from which the elongation will be performed. After fracturing the bone, an elongation of a maximum of 1 mm. per day is performed for several months, until the precise amount of elongation is achieved and the elongated area makes sufficient callus.

The main objective of treating upper extremity discrepancies is to obtain a useful limb.

The joints of the shoulder, elbow and wrist take precedence in importance over the length of the limb, which remains in the background. Humeral lengthening is the most common technique for correcting significant upper extremity dysmetries.

Most procedures coincide in the appearance of elbow and shoulder joint stiffness during the lengthening phase.

This limitation usually subsides with physical therapy after lengthening.

Where do we treat it?

IN NAVARRE AND MADRID

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