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BMJ Case Reports 2017; doi:10.1136/bcr-2017-220985
  • Reminder of important clinical lesson
  • CASE REPORT

Leg length discrepancy: the importance of a complete history and examination

  1. Simon Ball4
  1. 1Trauma and Orthopaedics, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
  2. 2General Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
  3. 3Trauma and Orthopaedics, East North Hertfordshire NHS Trust, Stevenage, UK
  4. 4Hand Surgery Unit, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
  1. Correspondence to Dr Duncan Coffey, duncan.coffey{at}doctors.org.uk
  • Accepted 12 November 2017
  • Published 2 December 2017

Summary

A 26-year-old woman with a 1-year history of right knee pain had failed to respond to analgesia and activity modification in the community. Her general practitioner referred her to the orthopaedic department for specialist review. A thorough history revealed that she had multiple orthopaedic interventions as a child. The patient had significant postoperative infection of the left knee following knee surgery at 7 years of age. Examination demonstrated the presence of a limp, scoliosis and suspected leg length discrepancy. Plain film radiography confirmed the presence of leg length discrepancy, with the right limb measuring 30 mm longer than the left. The leg length discrepancy was likely secondary to a growth arrest of the left knee following the postoperative infection in childhood. The patient was managed with physiotherapy and heel raises and received regular orthopaedic follow-up.

Footnotes

  • Contributors DC: Lead author, collated the information regarding the case and produced the text body and original drafts. SPH-P: Contributing author, produced the literature review and edited the initial drafts. SSR: Contributing author, coauthored the text body and provided senior advice on the case. SB: Supervisor, consultant in charge of patient care and reviewed and edited the final drafts.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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