This will be alook and proceed case
- [Stand and Look]
- From front
- Obvious LLD with hypertrophy of one limb - bigger in circumference and length
- Look for features of non idiopathic hemihypertrophy
- NF - cafespot
- Beckwith Wideman - tongue macroglossia
- Klippel Trennaunay Syndrome - portwine stain, varicose (triad)
- From side
- flexed posture of long limb
- Request for blocks to evaluate extent of LLD
- [Walk]
- Don’t expect trendelenberg gait
- Short limb gait with
- Toe gait, equinus contracture
- Circumduction on the long limb
- Look for aids and heel raises
- [Lie down]
- LLD assessment:
- When lying down naturally - measure apparent limb length from midline structure
- Square pelvis - measure true limb length
- Galeazzi test for femur vs tibia shortening
- Digital bryant’s triangle test
- Complete my examination
- Abdominal exam - for Wilm’s tumor (kidney tumor)
- History from parents and child
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