Growth Expectation in Children: Leg Length Discrepancy Related with Bone Tumor in Children

Sung Taek Jung; Kwang Cheul Jeong; Hyeong Won Park

doi:10.5292/jkbjts.2011.17.1.1

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Jung, Jeong, and Park: Growth Expectation in Children: Leg Length Discrepancy Related with Bone Tumor in Children

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J Korean Bone Joint Tumor Soc 2011;17(1):1-10.

Published online: 7 January 2011

DOI: https://doi.org/10.5292/jkbjts.2011.17.1.1

Growth Expectation in Children: Leg Length Discrepancy Related with Bone Tumor in Children

Sung Taek Jung, Kwang Cheul Jeong, Hyeong Won Park

Department of Orthopedic Surgery, Chonnam National University College of Medicine, Gwangju, Korea

Correspondence to: Sung Taek Jung, M.D., Ph.D. Department of Orthopedic Surgery, Chonnam National University Hospital, 8, Hak-dong, Dong-gu, Gwangju 501-757, Korea TEL: +82-62-227-1640 FAX: +82-62-225-7794 E-mail: stjung@chonnam.ac.kr

Received 22 February 201130 April 2011 Accepted 30 May 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The main goals of treatment of malignant bone tumor are the prolongation of life survival and the improvement of quality of life. In growing children, however, leg length discrepancy (LLD) is one of major problem in the treatment of malignant bone tumors. Therefore, the precise understanding of growth in children is essential, and the prediction of LLD is critical in deciding the time and options of surgery. In addition, to use the adequate method of growth expectation, periodic followup and collaboration with patient's parents are needed.

Keywords: bone tumor, leg length discrepancy, growth expectation

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Figure 1.

This graph showing pubertal growth in girls.

Figure 2.

This graph showing pubertal growth in boys.

Figure 3.

This showing the Sauvegrain method of assessing skeletal age.

Figure 4.

This showing the stages of closure of the olecrenon in relation to the pubertal growth and the Risser sign.

Figure 5.

These radiographs showing each stage of Risser Sign.

Figure 6.

This showing contributions of the various growth plates to the length of the lower limb and its individual bones.

Figure 7.

This showing an average total length of the femur and tibia with a 1 and 2 standard deviation range in girls based on chronologic age provided by Green and Anderson.

Figure 8.

Plain radiograph showing osteosarcoma on right proximal femur and reconstruction with tumor prosthesis of 7.6 years old patient.

Figure 9.

This showing the progression of leg length discrepancy in same patient.

Figure 10.

This drawing showing the Moseley straight-line graph.

Figure 11.

Plain radiographs showing osteosarcoma on left distal femur, reconstruction with allograft, and about 7 cm LLD after 4 years follow up.

Table 1.

Characteristics of Growth Pattern

Period	Characteristics
Intrauterine period	First 6 months: rapid length increase, reach 70% of expected birth length
Intrauterine period	Next 3 months: rapid weight gain
Birth-5 years	Most rapid growth rate, especially first year of life: double the birth height, 62% of the final height
Birth-5 years	Sitting height and leg length increase at the same rate
5 years-onset of puberty	Marked deceleration in growth: standing height increase at approximately 5.5 cm/year
5 years-onset of puberty	Leg length account for 2/3 of total gain in height
Puberty	Acceleration of growth velocity
	Increase of standing height: 20.5 cm (girls), 22.5 cm (boys)
	Sitting height account for 2/3 of total gain in height

Table 2.

Length of Femur and Tibia

		Femur	Tibia
At birth		9 cm	7 cm
At growth maturation	Girls	47 cm	37 cm
	Boys	44 cm	34 cm

Table 3.

Lower-limb Multipliers

Age	Multiplier		Age	Multiplier
(yrs∗+mos^†)	Boys	Girls	(yrs+mos)	Boys	Girls
Birth	5.080	4.630	7+6	1.520	1.370
0+3	4.550	4.155	8+0	1.470	1.330
0+6	4.050	3.725	8+6	1.420	1.290
0+9	3.600	3.300	9+0	1.380	1.260
1+0	3.240	2.970	9+6	1.340	1.220
1+3	2.975	2.750	10+0	1.310	1.190
1+6	2.825	2.600	10+6	1.280	1.160
1+9	2.700	2.490	11+0	1.240	1.130
2+0	2.590	2.390	11+6	1.220	1.100
2+3	2.480	2.295	12+0	1.180	1.070
2+6	2.385	2.200	12+6	1.160	1.050
2+9	2.300	2.125	13+0	1.130	1.030
3+0	2.230	2.050	13+6	1.100	1.010
3+6	2.110	1.925	14+0	1.080	1.000
4+0	2.000	1.830	14+6	1.060
4+6	1.890	1.740	15+0	1.040
5+0	1.820	1.660	15+6	1.020
5+6	1.740	1.580	16+0	1.010
6+0	1.670	1.510	16+6	1.010
6+6	1.620	1.460	17+0	1.000
7+0	1.570	1.430

^∗ yrs, years;

^† mos, months.

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