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__NOTOC__
__NOTOC__
{{SI}}
{{SI}}
{{CMG}}; {{VR}}
{{CMG}}; {{AE}} {{VR}}
 
{{SK}} Unequal leg length, leg length inequality, leg length alignment asymmetry
 
==Overview==
Leg length discrepancy is a medical condition where the [[leg]]s are of different sizes.  There are two main types of leg length inequalities.  The first type is caused by the legs themselves being measurably different in length as seen in [[birth defect]]s, [[fracture|broken leg]] or serious [[infection]].  The other, more common, type is refereed to as leg length alignment asymmetry, a condition where the short leg is unequal in length while in a supine or prone position.  Leg length alignment asymmetry can be the result of hypertonicity in the musculature of the [[pelvis]] or [[leg]].<ref>[http://www.chiroandosteo.com/content/13/1/12 Knutson, G. A. "Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part II, the functional or unloaded leg-length asymmetry".] Chiropractic & Osteopathy 2005, 13:12 doi:10.1186/1746-1340-13-12.</ref>
 
==Classification==
===Structural Leg Length Discrepancy===
Structural leg length discrepancy is caused by the legs themselves being measurably different in length, usually due to differences in the length of the [[femur]] in the thigh or the [[tibia]] and [[fibula]] bones in the lower leg.  This may be a [[birth defect]] or it may occur after a [[trauma|broken leg]], serious [[infection]], or local damage to one of the [[growth plate]]s in a leg.
 
===Functional Leg Length Discrepancy===
The other, more common, type is seen when the legs themselves are the same length, but due to [[neuromuscular]] injuries in the [[human pelvis|pelvis]] or upper leg, one leg or hip is held higher and tighter than the other ([[hypertonicity]] in the musculature of the pelvis or leg).  These unequally tightened muscles cause the legs to seem to be different lengths, even though careful measurement would show equal lengths of the actual leg.  This is called leg length alignment asymmetry and can be seen while lying down.<ref>Knutson, G. A.[http://www.chiroandosteo.com/content/13/1/12 "Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part II, the functional or unloaded leg-length asymmetry".] ''Chiropractic & Osteopathy'', 2005, 13:12 {{doi|10.1186/1746-1340-13-12}}.</ref>


==Causes==
==Causes==
===Life Threatening Causes ===
===Life Threatening Causes ===
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
*[[Appendicitis]]
*[[Aortoiliac occlusive disease |Leriche syndrome]]
*[[Meningitis]]
*[[Osteomyelitis]]
*[[Pelvic abscess]]
*[[Psoas abscess]]
*[[Septic arthritis]]
*[[Testicular torsion]]
===Common Causes===
===Common Causes===
*[[Avascular necrosis | Avascular necrosis of the hip]]
*[[Avascular necrosis | Avascular necrosis of the hip]]
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*[[Hip dysplasia (human) | Congenital dysplasia of the hip]]
*[[Hip dysplasia (human) | Congenital dysplasia of the hip]]
*[[Discitis]]
*[[Discitis]]
*Femur [[fracture]]
*[[Femur fracture]]
*[[Hip]] tightness and [[contracture]]
*[[Contracture|Hip contractures]]
*[[Legg-Calvé-Perthes syndrome]]
*[[Legg-Calvé-Perthes syndrome]]
*[[Scoliosis | Lumbar scoliosis]]
*[[Scoliosis | Lumbar scoliosis]]
Line 20: Line 43:
*[[Septic arthritis]]
*[[Septic arthritis]]
*[[Slipped capital femoral epiphysis]]
*[[Slipped capital femoral epiphysis]]
*[[Transient synovitis | Transient synovitis of the hip]]
*[[Transient synovitis | Transient synovitis of the hip]]<ref name="Gurney-2002">{{Cite journal  | last1 = Gurney | first1 = B. | title = Leg length discrepancy. | journal = Gait Posture | volume = 15 | issue = 2 | pages = 195-206 | month = Apr | year = 2002 | doi =  | PMID = 11869914 }}</ref><ref name="Raczkowski-2010">{{Cite journal  | last1 = Raczkowski | first1 = JW. | last2 = Daniszewska | first2 = B. | last3 = Zolynski | first3 = K. | title = Functional scoliosis caused by leg length discrepancy. | journal = Arch Med Sci | volume = 6 | issue = 3 | pages = 393-8 | month = Jun | year = 2010 | doi = 10.5114/aoms.2010.14262 | PMID = 22371777 }}</ref><ref name="Coppola-1999">{{Cite journal  | last1 = Coppola | first1 = C. | last2 = Maffulli | first2 = N. | title = Limb shortening for the management of leg length discrepancy. | journal = J R Coll Surg Edinb | volume = 44 | issue = 1 | pages = 46-54 | month = Feb | year = 1999 | doi =  | PMID = 10079669 }}</ref>


===Causes by Organ System===
===Causes by Organ System===
{|style="width:82%; height:100px" border="1"
{|style="width:82%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Atherosclerosis]],  [[AV fistula]],  [[Peripheral arterial disease | claudication of limb]],  [[Cystic medial necrosis|Erdheim cystic medial necrosis]],  [[Freiberg disease]],  [[hemangioma]],  [[hypertension]],  [[Klippel-Trenaunay-Weber syndrome]],  [[Aortoiliac occlusive disease | Leriche syndrome]],  [[limb ischemia]],  [[Parkes Weber syndrome]],  [[peripheral vascular disease]],  [[rheumatic disease]]
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Atherosclerosis]],  [[AV fistula]],  [[Peripheral arterial disease | claudication of limb]],  [[Cystic medial necrosis|Erdheim cystic medial necrosis]],  [[Osteochondritis|Freiberg's disease]],  [[hemangioma]],  [[hypertension]],  [[Klippel-Trenaunay-Weber syndrome]],  [[Aortoiliac occlusive disease | Leriche syndrome]],  [[limb ischemia]],  [[Parkes Weber syndrome]],  [[peripheral vascular disease]],  [[rheumatic disease]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
| '''Dermatologic'''
|bgcolor="Beige"| [[Cellulitis ]],  [[dermatomyositis]]  
|bgcolor="Beige"| [[Cellulitis]],  [[dermatomyositis]]  
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
| '''Endocrine'''
|bgcolor="Beige"|Arrest of [[Epiphyseal plate | physeal growth]],  [[hyperparathyroidism ]],  [[juvenile osteoporosis]]
|bgcolor="Beige"| [[Epiphyseal plate |Arrest of physeal growth]],  [[hyperparathyroidism]],  [[juvenile osteoporosis]]
|-  
|-  
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
Line 65: Line 88:
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
| '''Hematologic'''
|bgcolor="Beige"| [[Acute lymphoblastic leukemia ]],  [[Avascular necrosis | avascular necrosis of the hip]],  [[hemarthrosis]],  [[hemophilia]],  [[Multiple myeloma|Kahler's disease]],  [[Langerhans' cell histiocytosis ]],  [[leukemia]],  [[myelodysplasia]],  [[sickle-cell disease]]  
|bgcolor="Beige"| [[Acute lymphoblastic leukemia]],  [[Avascular necrosis | avascular necrosis of the hip]],  [[hemarthrosis]],  [[hemophilia]],  [[Multiple myeloma|Kahler's disease]],  [[Langerhans' cell histiocytosis]],  [[leukemia]],  [[myelodysplasia]],  [[sickle-cell disease]]  
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| '''Iatrogenic'''
|bgcolor="Beige"| [[Hip replacement]],  [[immunization]] [[(intramuscular injection)]],  [[Hip replacement|prosthetic hip replacement]],  [[radiation therapy]],  [[sympathectomy]]  
|bgcolor="Beige"| [[Hip replacement]],  [[intramuscular injection|immunization (intramuscular injection)]],  [[osteostimulation]],  [[Hip replacement|prosthetic hip replacement]],  [[radiation therapy]],  [[sympathectomy]]  
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| '''Infectious Disease'''
|bgcolor="Beige"| [[Acute rheumatic fever]],  [[cellulitis ]],  [[discitis]],  [[epididymitis]],  [[Abscess|epidural abscess of the spine]],  [[foot]] infection,  [[Neisseria gonorrhoeae|gonoccoccal arthritis]],  [[hand-foot-mouth disease ]],  [[Adenitis|iliac adenitis]],  [[Lymphadenopathy|inguinal lymphadenitis]],  [[Chronic recurrent multifocal osteomyelitis|juvenile chronic recurrent multifocal osteomyelitis]],  [[Lyme disease|Lyme arthritis]],  [[meningitis]],  [[myositis]],  [[observation hip syndrome]],  [[orchitis]],  [[osteomyelitis]],  [[paronychia ]],  [[pelvic abscess]],  [[pelvic inflammatory disease ]],  [[perirectal abscess]],  [[poliomyelitis]],  [[psoas abscess]],  [[reactive arthritis]],  [[sacroiliitis]],  [[septic arthritis]],  [[Transient synovitis | transient synovitis of the hip]]
|bgcolor="Beige"| [[Acute rheumatic fever]],  [[athlete's foot]],  [[cellulitis]],  [[discitis]],  [[epididymitis]],  [[Abscess|epidural abscess of the spine]],  [[Neisseria gonorrhoeae|gonoccoccal arthritis]],  [[hand-foot-mouth disease]],  [[Adenitis|iliac adenitis]],  [[Lymphadenopathy|inguinal lymphadenitis]],  [[Chronic recurrent multifocal osteomyelitis|juvenile chronic recurrent multifocal osteomyelitis]],  [[Lyme disease|Lyme arthritis]],  [[meningitis]],  [[myositis]],  [[Transient synovitis|observation hip syndrome]],  [[orchitis]],  [[osteomyelitis]],  [[paronychia ]],  [[pelvic abscess]],  [[pelvic inflammatory disease]],  [[perirectal abscess]],  [[poliomyelitis]],  [[psoas abscess]],  [[reactive arthritis]],  [[sacroiliitis]],  [[septic arthritis]],  [[Transient synovitis | transient synovitis of the hip]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| [[Arthropathy ]],  [[Baker's cyst]],  [[Blount's disease]],  [[Chondromalacia patellae|chondromalacia of the patella]],  [[Club foot|congenital club foot]],  [[Hip dysplasia (human) | congenital dysplasia of the hip]],  congenital limb [[aplasia]],  congenital limb [[hypoplasia]],  congenital [[pseudarthrosis]] of the tibia,  [[Rocker bottom foot|congenital Vertical Talus ]],  [[coxa vara]],  [[dermatomyositis]],  [[discitis]],  [[distraction]],  [[Muscle atrophy|disuse muscle atrophy]],  [[dystonia]],  [[enchondroma]],  [[Cystic medial necrosis|Erdheim cystic medial necrosis]],  [[fallen arches]],  [[Hemimelia | fibular hemimelia]],  [[gait abnormality]],  [[genu recurvatum]],  [[Bone healing|healed fractures]],  [[Atrophy|hemiatrophy]],  [[Hypertrophy (medical)|hemihypertrophy]],  [[Spinal disc herniation|herniated vertebral disc]],  [[Subluxation|hip subluxation]],  [[hip]] tightness and [[contracture]],  [[hypermobility syndrome]],  hypervascularity after [[fracture]],  [[juvenile arthritis]],  [[juvenile osteoporosis]],  [[juvenile rheumatoid arthritis]],  [[Klippel-Trenaunay-Weber syndrome]],  [[Kohler disease]],  [[Legg-Calvé-Perthes syndrome]],  [[Scoliosis | Lumbar scoliosis]],  [[Neuroblastoma|metastatic neuroblastoma]],  [[multiple hereditary exostoses]],  [[muscular dystrophy]],  [[Ollier's disease]],  [[ORIF|open reduction and internal fixation of fractures]],  [[Osgood-Schlatter disease]],  [[osteochondritis dissecans]],  [[osteogenesis imperfecta]],  [[Osteoma|osteoid osteoma]],  [[Repetitive strain injury|overuse syndrome]],  [[Chondromalacia patellae|patellofemoral pain syndrome]],  [[Bone fracture natural history, complications and prognosis|plastic deformation in pediatric fractures]],  [[prolonged immobilization ]],  [[proteus syndrome]],  [[proximal femoral focal deficiency]],  [[rheumatic disease]],  [[sciatica]],  [[Sever's disease]],  [[Osgood-Schlatter disease|Sinding-Larsen-Johansson disease]],  [[skeletal dysplasia]],  [[SLE]],  [[slipped capital femoral epiphysis]],  [[Spina bifida|spinal dysraphism]],  [[spondylolisthesis]],  [[Tarsal coalition|tarsal synostosis]],  [[tendonitis]],  [[tenosynovitis ]],  torsional [[deformity]],  [[Upington disease]]  
|bgcolor="Beige"| [[Arthropathy]],  [[Baker's cyst]],  [[Blount's disease]],  [[chondroblastoma]],  [[Chondromalacia patellae|chondromalacia of the patella]],  [[Club foot|congenital club foot]],  [[Hip dysplasia (human) | congenital dysplasia of the hip]],  [[Amelia (birth defect)|congenital limb aplasia]],  [[Dysmelia|congenital limb hypoplasia]],  [[Neurofibromatosis type I|congenital pseudarthrosis of the tibia]],  [[Rocker bottom foot|congenital vertical talus]],  [[coxa vara]],  [[dermatomyositis]],  [[discitis]],  [[distraction]],  [[Muscle atrophy|disuse muscle atrophy]],  [[dystonia]],  [[enchondroma]],  [[Cystic medial necrosis|Erdheim cystic medial necrosis]],  [[fallen arches]],  [[Hemimelia | fibular hemimelia]],  [[gait abnormality]],  [[genu recurvatum]],  [[greenstick fracture]],  [[Bone healing|healed fractures]],  [[hemihypertrophy]],  [[Spinal disc herniation|herniated vertebral disc]],  [[Subluxation|hip subluxation]],  [[Contracture|hip contractures]],  [[hypermobility syndrome]],  [[Bone fracture|hypervascularity after fracture]],  [[juvenile arthritis]],  [[juvenile osteoporosis]],  [[juvenile rheumatoid arthritis]],  [[Klippel-Trenaunay-Weber syndrome]],  [[Kohler disease]],  [[Legg-Calvé-Perthes syndrome]],  [[Scoliosis | lumbar scoliosis]], [[Bone tumor|benign bone tumours]],  [[Neuroblastoma|metastatic neuroblastoma]],  [[multiple hereditary exostoses]],  [[muscular dystrophy]],  [[Ollier's disease]],  [[ORIF|open reduction and internal fixation of fractures]],  [[Osgood-Schlatter disease]],  [[osteoblastoma]],  [[osteochondritis dissecans]],  [[osteogenesis imperfecta]],  [[Osteoma|osteoid osteoma]],  [[osteosclerosis]],  [[osteostimulation]],  [[Repetitive strain injury|overuse syndrome]],  [[Chondromalacia patellae|patellofemoral pain syndrome]],  [[Bone fracture|plastic deformation in pediatric fractures]],  [[Paralysis|prolonged immobilization]],  [[proteus syndrome]],  [[proximal femoral focal deficiency]],  [[rheumatic disease]],  [[sciatica]],  [[Sever's disease]],  [[Osgood-Schlatter disease|Sinding-Larsen-Johansson disease]],  [[skeletal dysplasia]],  [[SLE]],  [[slipped capital femoral epiphysis]],  [[Spina bifida|spinal dysraphism]],  [[spondylolisthesis]],  [[Tarsal coalition|tarsal synostosis]],  [[tendonitis]],  [[tenosynovitis]],  [[Upington disease]]  
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
| '''Neurologic'''
|bgcolor="Beige"| [[Brain tumor]],  [[Cerebral palsy]],  [[Dystonia]],  [[Hip tightness and contracture]],  [[Lumbar scoliosis]],  [[Meningitis]], [[Metastatic neuroblastoma]],  [[Multiple sclerosis]],  [[Neurofibromatosis]],  [[Neurofibrosarcoma]],  [[Peripheral neuropathy]],  [[Poliomyelitis]],  [[Sciatica]]
|bgcolor="Beige"| [[Brain tumor]],  [[cerebral palsy]],  [[dystonia]],  [[Contracture|hip contractures]],  [[Scoliosis | lumbar scoliosis]],  [[meningitis]],   [[Neuroblastoma|metastatic neuroblastoma]],  [[multiple sclerosis]],  [[neurofibromatosis]],  [[neurofibrosarcoma]],  [[peripheral neuropathy]],  [[poliomyelitis]],  [[sciatica]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| [[Arrest of physeal growth]],  [[Arthropathy ]],  [[Juvenile osteoporosis]],  [[Lumbar scoliosis]],  [[Obesity]],  [[Rickets ]]
|bgcolor="Beige"|[[Epiphyseal plate |  Arrest of physeal growth]],  [[arthropathy]],  [[juvenile osteoporosis]],  [[Scoliosis | lumbar scoliosis]],  [[obesity]],  [[rickets ]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| [[Pelvic inflammatory disease ]]
|bgcolor="Beige"| [[Pelvic inflammatory disease]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
| '''Oncologic'''
|bgcolor="Beige"| [[Acute lymphoblastic leukemia ]],  [[Benign bone tumours ]],  [[Brain tumor]],  [[Ewings sarcoma]],  [[Langerhans' cell histiocytosis ]],  [[Leukemia]],  [[Malignant Bone tumors]],  [[Malignant fibrous histiocytoma]], [[Metastatic neuroblastoma]],  [[Neurofibrosarcoma]],  [[Osteogenic sarcoma]],  [[Sclerotic lesion of L5 pedicle ]],  [[Spinal cord tumor]],  [[Tumors across epiphysis]]  
|bgcolor="Beige"| [[Acute lymphoblastic leukemia]],  [[Bone tumor|benign bone tumours]],  [[brain tumor]],  [[chondroblastoma]],  [[Ewings sarcoma]],  [[Langerhans' cell histiocytosis]],  [[leukemia]],  [[Bone tumor|malignant bone tumors]],  [[malignant fibrous histiocytoma]],   [[Neuroblastoma|metastatic neuroblastoma]],  [[neurofibrosarcoma]],  [[osteoblastoma]],  [[osteosarcoma]],  [[spinal cord]] [[tumour]],  [[Epiphyseal plate|tumour across epiphyseal plate]]  
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| [[Acute rheumatic fever]],  [[Ankylosing spondylitis ]],  [[Arthropathy ]],  [[Baker cyst]],  [[Dermatomyositis]],  [[Henoch-schonlein purpura]],  [[Herniated vertebral disc]],  [[Inflammatory bowel disease]],  [[Juvenile arthritis]],  [[Juvenile rheumatoid arthritis]],  [[Myositis]],  [[Reactive arthritis]],  [[Rheumatic disease]],  [[Rheumatoid arthritis]],  [[Sacroilitis]],  [[Serum sickness]],  [[SLE]]
|bgcolor="Beige"| [[Acute rheumatic fever]],  [[ankylosing spondylitis]],  [[arthropathy]],  [[Baker's cyst]],  [[dermatomyositis]],  [[Henoch-Schönlein purpura]],  [[Spinal disc herniation|herniated vertebral disc]],  [[inflammatory bowel disease]],  [[juvenile arthritis]],  [[juvenile rheumatoid arthritis]],  [[myositis]],  [[reactive arthritis]],  [[rheumatic disease]],  [[rheumatoid arthritis]],  [[sacroiliitis]],  [[serum sickness]],  [[SLE]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Sexual'''
| '''Sexual'''
|bgcolor="Beige"| [[Epididymo-orchitis]],  [[Intermittent torsion of testis]]
|bgcolor="Beige"| [[Epididymitis]],  [[testicular torsion]],  [[orchitis]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Trauma'''
| '''Trauma'''
|bgcolor="Beige"| [[Ankle sprain ]],  [[Arthralagia ]],  [[Avascular necrosis of the hip ]],  [[Avulsion injury]],  [[Child abuse]],  [[Complex regional pain syndrome ]],  [[Contusion]],  [[Coxa vara]],  [[Discitis]],  [[Femur fracture ]],  [[Fixed pelvic obliquity ]],  [[Foot foreign body]],  [[Foot fractures]],  [[Fracture stimulation]],  [[Freiberg disease]],  [[Haematoma of thigh ]],  [[Healed fractures]],  [[Hemarthrosis]],  [[Herniated vertebral disc]],  [[Hip dislocation ]],  [[Hip subluxation]],  [[Hypervascularity after fracture]],  [[Intermittent torsion of testis]],  [[Knee sprain]],  [[Limb ischaemia]],  [[Malunion]],  [[Muscle strain]],  [[Neck of femur fracture]],  [[Non union]],  [[Observation hip syndrome]],  [[Open reduction and internal fixation of fractures]], [[Overriding fractures]],  [[Patellar dislocation]],  [[Patellofemoral pain]],  [[Periostitis]],  [[Ruptured achilles tendon]],  [[Sacroilitis]],  [[Salter-harris fracture]],  [[Sciatica]],  [[Spondylolisthesis]],  [[Stress fracture]],  [[Tendonitis]],  [[Tenosynovitis ]],  [[Tibial Fracture]],  [[Toddler's fracture]]
|bgcolor="Beige"| [[Ankle sprain]],  [[arthralgia]],  [[Avascular necrosis | avascular necrosis of the hip]],  [[Avulsion fracture|avulsion injury]],  [[child abuse]],  [[complex regional pain syndrome]],  [[contusion]],  [[coxa vara]],  [[discitis]],  [[femur]] [[fracture]],  [[Polio|fixed pelvic obliquity]],  [[Foreign body|foot foreign body]],  [[Bone fracture|foot fractures]],  [[Osteochondritis|Freiberg's disease]],  [[greenstick fracture]],  [[Hematoma|hematoma of thigh]],  [[Bone fracture|healed fractures]],  [[hemarthrosis]],  [[Spinal disc herniation|herniated vertebral disc]],  [[hip dislocation]],  [[Subluxation|hip subluxation]],  [[Bone fracture|hypervascularity after fracture]],  [[testicular torsion]],  [[knee sprain]],  [[limb ischemia]],  [[Bone fracture|malunion]],  [[muscle strain]],  [[femur fracture]],  [[Fracture nonunion|nonunion]],  [[Transient synovitis|observation hip syndrome]],  [[ORIF|open reduction and internal fixation of fractures]], [[patellar dislocation]],  [[Chondromalacia patellae|patellofemoral pain syndrome]],  [[periostitis]],  [[Achilles tendon|ruptured achilles tendon]],  [[sacroiliitis]],  [[Salter-Harris fracture]],  [[sciatica]],  [[spondylolisthesis]],  [[stress fracture]],  [[tendonitis]],  [[tenosynovitis]],  [[Bone fracture classification|tibial fracture]],  [[toddler fracture]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
Line 140: Line 163:
{{col-begin|width=85%}}
{{col-begin|width=85%}}
{{col-break|width=33%}}
{{col-break|width=33%}}
*[[Acute lymphoblastic leukemia ]]
*[[Acute lymphoblastic leukemia]]
*[[Acute rheumatic fever]]
*[[Acute rheumatic fever]]
*[[Ankle sprain ]]
*[[Ankle sprain]]
*[[Ankylosing spondylitis ]]
*[[Ankylosing spondylitis]]
*[[Apophysitis]]
*[[Osgood-Schlatter disease|Apophysitis]]
*[[Appendicitis]]
*[[Appendicitis]]
*[[Arrest of physeal growth]]
* [[Epiphyseal plate | Arrest of physeal growth]]
*[[Arthralagia ]]
*[[Arthralgia]]
*[[Arthropathy ]]
*[[Arthropathy]]
*[[Atherosclerosis]]
*[[Atherosclerosis]]
*[[Athlete's foot]]
*[[AV fistula]]
*[[AV fistula]]
*[[Avascular necrosis of the hip ]]
*[[Avascular necrosis | Avascular necrosis of the hip]]
*[[Avulsion injury]]
*[[Avulsion fracture|Avulsion injury]]
*[[Baker cyst]]
*[[Baker's cyst]]
*[[Benign bone tumours ]]
*[[Bone tumor|Benign bone tumours]]
*[[Blount disease]]
*[[Blount's disease]]
*[[Brain tumor]]
*[[Brain tumor]]
*[[Cellulitis ]]
*[[Cellulitis]]
*[[Cerebral palsy]]
*[[Cerebral palsy]]
*[[Child abuse]]
*[[Child abuse]]
*[[Chondromalacia of the patella]]
*[[Chondroblastoma]]
*[[Chondromalacia patellae ]]
*[[Chondromalacia patellae]]
*[[Claudication of limb]]
*[[Peripheral arterial disease | Claudication of limb]]
*[[Complex regional pain syndrome ]]
*[[Complex regional pain syndrome]]
*[[Congenital club foot]]
*[[Club foot|Congenital club foot]]
*[[Congenital dysplasia of hip]]
*[[Hip dysplasia (human) | Congenital dysplasia of the hip]]
*[[Congenital limb aplasia]]
*[[Amelia (birth defect)|Congenital limb aplasia]]
*[[Congenital limb hypoplasia]]
*[[Dysmelia|Congenital limb hypoplasia]]
*[[Congenital pseudarthrosis of the tibia]]
*[[Neurofibromatosis type I|Congenital pseudarthrosis of the tibia]]
*[[Congenital Vertical Talus ]]
*[[Rocker bottom foot|Congenital vertical talus ]]
*[[Contusion]]
*[[Contusion]]
*[[Conversion disorder]]
*[[Conversion disorder]]
Line 176: Line 200:
*[[Discitis]]
*[[Discitis]]
*[[Distraction]]
*[[Distraction]]
*[[Disuse muscle atrophy]]
*[[Muscle atrophy|Disuse muscle atrophy]]
*[[Dystonia]]
*[[Dystonia]]
*[[Enchondroma]]
*[[Enchondroma]]
*[[Epididymitis]]
*[[Epididymitis]]
*[[Epidural abscess of the spine]]
*[[Abscess|Epidural abscess of the spine]]
*[[Erdheim cystic medial necrosis]]
*[[Cystic medial necrosis|Erdheim cystic medial necrosis]]
*[[Ewings sarcoma]]
*[[Ewings sarcoma]]
*[[Fallen arches]]
*[[Fallen arches]]
*[[Femur fracture ]]
*[[Femur fracture]]
*[[Fibular hemimelia]]
*[[Hemimelia | Fibular hemimelia]]
*[[Fixed pelvic obliquity ]]
*[[Polio|Fixed pelvic obliquity]]<ref name="Lee-1997">{{Cite journal  | last1 = Lee | first1 = DY. | last2 = Choi | first2 = IH. | last3 = Chung | first3 = CY. | last4 = Cho | first4 = TJ. | last5 = Lee | first5 = JC. | title = Fixed pelvic obliquity after poliomyelitis: classification and management. | journal = J Bone Joint Surg Br | volume = 79 | issue = 2 | pages = 190-6 | month = Mar | year = 1997 | doi =  | PMID = 9119840 }}</ref>
*[[Foot foreign body]]
*[[Foreign body|Foot foreign body]]
*[[Foot fractures]]
*[[Bone fracture|Foot fractures]]
*[[Foot infection]]
*[[Osteochondritis|Freiberg disease]]
*[[Fracture stimulation]]
*[[Gait abnormality]]
*[[Freiberg disease]]
*[[Gait abnormalities]]
*[[Genu recurvatum]]
*[[Genu recurvatum]]
*[[Gonoccoccal arthritis]]
*[[Greenstick fracture]]
*[[Haematoma of thigh ]]
*[[Neisseria gonorrhoeae|Gonoccoccal arthritis]]
*[[Hand-foot-mouth disease ]]
*[[Hand-foot-mouth disease]]
*[[Healed fractures]]
*[[Bone healing|Healed fractures]]
*[[Hemangioma]]
*[[Hemangioma]]
{{col-break|width=33%}}
{{col-break|width=33%}}
*[[Hemarthrosis]]
*[[Hemarthrosis]]
*[[Hemiatrophy]]
*[[Hematoma|Hematoma of thigh]]
*[[Hemihypertrophy]]
*[[Hemihypertrophy]]
*[[Hemophilia]]
*[[Hemophilia]]
*[[Henoch-Schonlein purpura]]
*[[Henoch-Schonlein purpura]]
*[[Herniated vertebral disc]]
*[[Spinal disc herniation|Herniated vertebral disc]]
*[[Hip dislocation ]]
*[[Hip dislocation]]
*[[Hip replacement]]
*[[Hip replacement]]
*[[Hip subluxation]]
*[[Subluxation|Hip subluxation]]
*[[Hip tightness and contracture]]
*[[Contracture|Hip contractures]]
*[[Hypermobility syndrome]]
*[[Hypermobility syndrome]]
*[[Hyperparathyroidism ]]
*[[Hyperparathyroidism]]
*[[Hypertension]]
*[[Hypertension]]
*[[Hypervascularity after fracture]]
*[[Bone fracture|Hypervascularity after fracture]]
*[[Idiopathic]]
*[[Idiopathic]]
*[[Iliac adenitis]]
*[[Adenitis|Iliac adenitis]]
*[[Immunization (im shot)]]
*[[intramuscular injection|Immunization (intramuscular injection)]]
*[[Incomplete fracture: buckle, greenstick]]
*[[Inflammatory bowel disease]]
*[[Inflammatory bowel disease]]
*[[Inguinal lymphadenitis ]]
*[[Lymphadenopathy|inguinal lymphadenitis]]
*[[Intermittent torsion of testis]]
*[[Juvenile arthritis]]
*[[Juvenile arthritis]]
*[[Juvenile chronic recurrent multifocal osteomyelitis]]
*[[Chronic recurrent multifocal osteomyelitis|Juvenile chronic recurrent multifocal osteomyelitis]]
*[[Juvenile osteoporosis]]
*[[Juvenile osteoporosis]]
*[[Juvenile rheumatoid arthritis]]
*[[Juvenile rheumatoid arthritis]]
*[[Kahler disease]]
*[[Multiple myeloma|Kahler's disease]]
*[[Klippel-trenaunay-weber syndrome]]
*[[Klippel-Trenaunay-Weber syndrome]]
*[[Knee sprain]]
*[[Knee sprain]]
*[[Kohler disease]]
*[[Kohler disease]]
*[[Langerhans' cell histiocytosis ]]
*[[Langerhans' cell histiocytosis]]
*[[Legg-calve-perthes disease]]
*[[Legg-Calvé-Perthes syndrome]]
*[[Leriche syndrome]]
*[[Aortoiliac occlusive disease | Leriche syndrome]]
*[[Leukemia]]
*[[Leukemia]]
*[[Limb ischemia]]
*[[Limb ischemia]]
*[[Lumbar scoliosis]]
*[[Scoliosis | Lumbar scoliosis]]
*[[Lyme arthritis]]
*[[Lyme disease|Lyme arthritis]]
*[[Malignant Bone tumors]]
*[[Bone tumor | Malignant bone tumors]]
*[[Malignant fibrous histiocytoma]]
*[[Malignant fibrous histiocytoma]]
*[[Malunion]]
*[[Bone fracture|Malunion]]
*[[Meningitis]]
*[[Meningitis]]
*[[Metastatic neuroblastoma]]
*[[Neuroblastoma|Metastatic neuroblastoma]]
*[[Multiple hereditary exostoses]]
*[[Multiple hereditary exostoses]]
*[[Multiple sclerosis]]
*[[Multiple sclerosis]]
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*[[Myelodysplasia]]
*[[Myelodysplasia]]
*[[Myositis]]
*[[Myositis]]
*[[Neck of femur fracture]]
*[[Femur fracture|Neck of femur fracture]]
*[[Neurofibromatosis]]
*[[Neurofibromatosis]]
*[[Neurofibrosarcoma]]
*[[Neurofibrosarcoma]]
*[[Non union]]
*[[Fracture nonunion|Nonunion]]
*[[Obesity]]
*[[Obesity]]
*[[Observation hip syndrome]]
*[[Transient synovitis|Observation hip syndrome]]<ref name="FERNANDEZDE VALDERRAMA-1963">{{Cite journal  | last1 = FERNANDEZDE VALDERRAMA | first1 = . | title = THE OBSERVATION HIP SYNDROME AND ITS LATE SEQUELAE. | journal = J Bone Joint Surg Br | volume = 45 | issue =  | pages = 462-70 | month = Aug | year = 1963 | doi =  | PMID = 14065262 }}</ref>
*[[Ollier disease]]
*[[Ollier's disease]]
*[[Open reduction and internal fixation of fractures]]
*[[ORIF|Open reduction and internal fixation of fractures]]
*[[Orchitis]]
*[[Orchitis]]
*[[Osgood-Schlatter disease]]
*[[Osgood-Schlatter disease]]
*[[Osteoblastoma]]
*[[Osteochondritis dissecans]]
*[[Osteochondritis dissecans]]
{{col-break|width=33%}}
*[[Osteogenesis imperfecta]]
*[[Osteogenesis imperfecta]]
{{col-break|width=33%}}
*[[Osteosclerosis]]
*[[Osteogenic sarcoma]]
*[[Osteostimulation]]
*[[Osteoid osteoma]]
*[[Osteosarcoma]]
*[[Osteoma|Osteoid osteoma]]
*[[Osteomyelitis]]
*[[Osteomyelitis]]
*[[Overriding fractures]]
*[[Repetitive strain injury|Overuse syndrome]]
*[[Overuse syndromes]]
*[[Parkes Weber syndrome]]
*[[Parkes weber syndrome]]
*[[Paronychia ]]
*[[Paronychia ]]
*[[Patellar dislocation]]
*[[Patellar dislocation]]
*[[Patellofemoral pain]]
*[[Chondromalacia patellae|Patellofemoral pain syndrome]]
*[[Pelvic abscess]]
*[[Pelvic abscess]]
*[[Pelvic inflammatory disease ]]
*[[Pelvic inflammatory disease]]
*[[Periostitis]]
*[[Periostitis]]
*[[Peripheral neuropathy]]
*[[Peripheral neuropathy]]
*[[Peripheral vascular disease]]
*[[Peripheral vascular disease]]
*[[Perirectal abscess]]
*[[Perirectal abscess]]
*[[Plastic fracture]]
*[[Bone fracture|Plastic deformation in pediatric fractures]]
*[[Poliomyelitis]]
*[[Poliomyelitis]]
*[[Poor posture]]
*[[Paralysis|Prolonged immobilization ]]
*[[Prolonged immobilization ]]
*[[Hip replacement|Prosthetic hip replacement]]
*[[Prosthetic hip replacement]]
*[[Proteus syndrome]]
*[[Proteus syndrome]]
*[[Proximal femoral focal deficiency]]
*[[Proximal femoral focal deficiency]]
Line 288: Line 309:
*[[Rheumatoid arthritis]]
*[[Rheumatoid arthritis]]
*[[Rickets ]]
*[[Rickets ]]
*[[Ruptured achilles tendon]]
*[[Achilles tendon|Ruptured achilles tendon]]
*[[Russell-silver syndrome]]
*[[Russell-Silver syndrome]]
*[[Sacroiliitis]]
*[[Sacroiliitis]]
*[[Salter-harris fracture]]
*[[Salter-Harris fracture]]
*[[Sciatica]]
*[[Sciatica]]
*[[Sclerotic lesion of L5 pedicle ]]
*[[Septic arthritis]]
*[[Septic arthritis]]
*[[Serum sickness]]
*[[Serum sickness]]
*[[Sever disease]]
*[[Sever's disease]]
*[[Sickle-cell disease ]]
*[[Sickle-cell disease ]]
*[[Sinding-larsen-johansson disease]]
*[[Osgood-Schlatter disease|Sinding-Larsen-Johansson disease]]
*[[Skeletal dysplasia]]
*[[Skeletal dysplasia]]
*[[SLE]]
*[[SLE]]
*[[Slipped capital femoral epiphysis]]
*[[Slipped capital femoral epiphysis]]
*[[Spinal cord tumor]]
*[[Spinal cord tumor]]
*[[Spinal dysraphism ]]
*[[Spina bifida|Spinal dysraphism]]
*[[Spondylolisthesis]]
*[[Spondylolisthesis]]
*[[Stress fracture]]
*[[Stress fracture]]
*[[Sympathectomy]]
*[[Sympathectomy]]
*[[Tarsal coalition]]
*[[Tarsal coalition]]
*[[Tarsal synostosis]]
*[[Tarsal coalition|Tarsal synostosis]]
*[[Tendonitis]]
*[[Tendonitis]]
*[[Tenosynovitis ]]
*[[Tenosynovitis]]
*[[Tibial Fracture]]
*[[Testicular torsion]]
*[[Toddler's fracture]]
*[[Bone fracture classification|Tibial fracture]]
*[[Torsional deformities ]]
*[[Toddler fracture]]
*[[Transient synovitis of the hip]]
*[[Transient synovitis | Transient synovitis of the hip]]
*[[Tumors across epiphysis]]
*[[Upington disease]]
*[[Upington disease]]
*[[Wilm's tumor]]
*[[Wilm's tumor]]
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{{Reflist|2}}
{{Reflist|2}}


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Latest revision as of 18:06, 9 June 2015

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vendhan Ramanujam M.B.B.S [2]

Synonyms and keywords: Unequal leg length, leg length inequality, leg length alignment asymmetry

Overview

Leg length discrepancy is a medical condition where the legs are of different sizes. There are two main types of leg length inequalities. The first type is caused by the legs themselves being measurably different in length as seen in birth defects, broken leg or serious infection. The other, more common, type is refereed to as leg length alignment asymmetry, a condition where the short leg is unequal in length while in a supine or prone position. Leg length alignment asymmetry can be the result of hypertonicity in the musculature of the pelvis or leg.[1]

Classification

Structural Leg Length Discrepancy

Structural leg length discrepancy is caused by the legs themselves being measurably different in length, usually due to differences in the length of the femur in the thigh or the tibia and fibula bones in the lower leg. This may be a birth defect or it may occur after a broken leg, serious infection, or local damage to one of the growth plates in a leg.

Functional Leg Length Discrepancy

The other, more common, type is seen when the legs themselves are the same length, but due to neuromuscular injuries in the pelvis or upper leg, one leg or hip is held higher and tighter than the other (hypertonicity in the musculature of the pelvis or leg). These unequally tightened muscles cause the legs to seem to be different lengths, even though careful measurement would show equal lengths of the actual leg. This is called leg length alignment asymmetry and can be seen while lying down.[2]

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Causes by Organ System

Cardiovascular Atherosclerosis, AV fistula, claudication of limb, Erdheim cystic medial necrosis, Freiberg's disease, hemangioma, hypertension, Klippel-Trenaunay-Weber syndrome, Leriche syndrome, limb ischemia, Parkes Weber syndrome, peripheral vascular disease, rheumatic disease
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic Cellulitis, dermatomyositis
Drug Side Effect Avascular necrosis of the hip, myositis, serum sickness
Ear Nose Throat No underlying causes
Endocrine Arrest of physeal growth, hyperparathyroidism, juvenile osteoporosis
Environmental No underlying causes
Gastroenterologic Appendicitis, inflammatory bowel disease
Genetic Fibular hemimelia, Klippel-Trenaunay-Weber syndrome, osteochondritis dissecans, osteogenesis imperfecta, proteus syndrome, Russell-Silver syndrome, tarsal coalition, Upington disease
Hematologic Acute lymphoblastic leukemia, avascular necrosis of the hip, hemarthrosis, hemophilia, Kahler's disease, Langerhans' cell histiocytosis, leukemia, myelodysplasia, sickle-cell disease
Iatrogenic Hip replacement, immunization (intramuscular injection), osteostimulation, prosthetic hip replacement, radiation therapy, sympathectomy
Infectious Disease Acute rheumatic fever, athlete's foot, cellulitis, discitis, epididymitis, epidural abscess of the spine, gonoccoccal arthritis, hand-foot-mouth disease, iliac adenitis, inguinal lymphadenitis, juvenile chronic recurrent multifocal osteomyelitis, Lyme arthritis, meningitis, myositis, observation hip syndrome, orchitis, osteomyelitis, paronychia , pelvic abscess, pelvic inflammatory disease, perirectal abscess, poliomyelitis, psoas abscess, reactive arthritis, sacroiliitis, septic arthritis, transient synovitis of the hip
Musculoskeletal/Orthopedic Arthropathy, Baker's cyst, Blount's disease, chondroblastoma, chondromalacia of the patella, congenital club foot, congenital dysplasia of the hip, congenital limb aplasia, congenital limb hypoplasia, congenital pseudarthrosis of the tibia, congenital vertical talus, coxa vara, dermatomyositis, discitis, distraction, disuse muscle atrophy, dystonia, enchondroma, Erdheim cystic medial necrosis, fallen arches, fibular hemimelia, gait abnormality, genu recurvatum, greenstick fracture, healed fractures, hemihypertrophy, herniated vertebral disc, hip subluxation, hip contractures, hypermobility syndrome, hypervascularity after fracture, juvenile arthritis, juvenile osteoporosis, juvenile rheumatoid arthritis, Klippel-Trenaunay-Weber syndrome, Kohler disease, Legg-Calvé-Perthes syndrome, lumbar scoliosis, benign bone tumours, metastatic neuroblastoma, multiple hereditary exostoses, muscular dystrophy, Ollier's disease, open reduction and internal fixation of fractures, Osgood-Schlatter disease, osteoblastoma, osteochondritis dissecans, osteogenesis imperfecta, osteoid osteoma, osteosclerosis, osteostimulation, overuse syndrome, patellofemoral pain syndrome, plastic deformation in pediatric fractures, prolonged immobilization, proteus syndrome, proximal femoral focal deficiency, rheumatic disease, sciatica, Sever's disease, Sinding-Larsen-Johansson disease, skeletal dysplasia, SLE, slipped capital femoral epiphysis, spinal dysraphism, spondylolisthesis, tarsal synostosis, tendonitis, tenosynovitis, Upington disease
Neurologic Brain tumor, cerebral palsy, dystonia, hip contractures, lumbar scoliosis, meningitis, metastatic neuroblastoma, multiple sclerosis, neurofibromatosis, neurofibrosarcoma, peripheral neuropathy, poliomyelitis, sciatica
Nutritional/Metabolic Arrest of physeal growth, arthropathy, juvenile osteoporosis, lumbar scoliosis, obesity, rickets
Obstetric/Gynecologic Pelvic inflammatory disease
Oncologic Acute lymphoblastic leukemia, benign bone tumours, brain tumor, chondroblastoma, Ewings sarcoma, Langerhans' cell histiocytosis, leukemia, malignant bone tumors, malignant fibrous histiocytoma, metastatic neuroblastoma, neurofibrosarcoma, osteoblastoma, osteosarcoma, spinal cord tumour, tumour across epiphyseal plate
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric Conversion disorder
Pulmonary No underlying causes
Renal/Electrolyte Wilm's tumor
Rheumatology/Immunology/Allergy Acute rheumatic fever, ankylosing spondylitis, arthropathy, Baker's cyst, dermatomyositis, Henoch-Schönlein purpura, herniated vertebral disc, inflammatory bowel disease, juvenile arthritis, juvenile rheumatoid arthritis, myositis, reactive arthritis, rheumatic disease, rheumatoid arthritis, sacroiliitis, serum sickness, SLE
Sexual Epididymitis, testicular torsion, orchitis
Trauma Ankle sprain, arthralgia, avascular necrosis of the hip, avulsion injury, child abuse, complex regional pain syndrome, contusion, coxa vara, discitis, femur fracture, fixed pelvic obliquity, foot foreign body, foot fractures, Freiberg's disease, greenstick fracture, hematoma of thigh, healed fractures, hemarthrosis, herniated vertebral disc, hip dislocation, hip subluxation, hypervascularity after fracture, testicular torsion, knee sprain, limb ischemia, malunion, muscle strain, femur fracture, nonunion, observation hip syndrome, open reduction and internal fixation of fractures, patellar dislocation, patellofemoral pain syndrome, periostitis, ruptured achilles tendon, sacroiliitis, Salter-Harris fracture, sciatica, spondylolisthesis, stress fracture, tendonitis, tenosynovitis, tibial fracture, toddler fracture
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order

References

  1. ↑ Knutson, G. A. "Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part II, the functional or unloaded leg-length asymmetry". Chiropractic & Osteopathy 2005, 13:12 doi:10.1186/1746-1340-13-12.
  2. ↑ Knutson, G. A."Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part II, the functional or unloaded leg-length asymmetry". Chiropractic & Osteopathy, 2005, 13:12 doi:10.1186/1746-1340-13-12.
  3. ↑ Gurney, B. (2002). "Leg length discrepancy". Gait Posture. 15 (2): 195–206. PMID 11869914. Unknown parameter |month= ignored (help)
  4. ↑ Raczkowski, JW.; Daniszewska, B.; Zolynski, K. (2010). "Functional scoliosis caused by leg length discrepancy". Arch Med Sci. 6 (3): 393–8. doi:10.5114/aoms.2010.14262. PMID 22371777. Unknown parameter |month= ignored (help)
  5. ↑ Coppola, C.; Maffulli, N. (1999). "Limb shortening for the management of leg length discrepancy". J R Coll Surg Edinb. 44 (1): 46–54. PMID 10079669. Unknown parameter |month= ignored (help)
  6. ↑ Lee, DY.; Choi, IH.; Chung, CY.; Cho, TJ.; Lee, JC. (1997). "Fixed pelvic obliquity after poliomyelitis: classification and management". J Bone Joint Surg Br. 79 (2): 190–6. PMID 9119840. Unknown parameter |month= ignored (help)
  7. ↑ FERNANDEZDE VALDERRAMA, . (1963). "THE OBSERVATION HIP SYNDROME AND ITS LATE SEQUELAE". J Bone Joint Surg Br. 45: 462–70. PMID 14065262. Unknown parameter |month= ignored (help)


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