AN INQUIRY AS TO THE PRACTICABILITY OF EQUALIZING UNEQUAL LEGS BY OPERATION

1. The question of the practicability of equalizing unequal legs by operation should not be prejudged through the demonstrated impracticability of some of the methods used in the cases reported here.

2. Three-quarters of an inch can be added to the length of a femur, but at a cost of time and hardship too great in comparison with the gain.

3. The reason that no more than three-quarters of an inch could be gained in these cases was not the danger to vessels and nerves, but the fact that these structures are all too well protected by the great strength of the fibrous tissue of the leg. If the problem were to be further studied along this line it would seem that the hope of greater gain would lie, not in the application of greater force, but in the clean division of more tendons, fascial bands, or intermuscular planes.

4. It is practicable to subtract two inches and a quarter (Cases 4 and 5) and, probably, three inches (Case 4), from the length of a femur without serious loss of muscle tone.

5. If the subtraction method is chosen, the simpler the technic the better. Much was hoped from a pattern of osteotomy in which the bone was split first by two longitudinal saw clefts in planes at right angles to each other, and transverse cuts made at two different levels so that four interlocking "fingers" were formed. In the model and in the cadaver, this allows a telescoping movement of the fragments which seems compatible with great firmness. But in the elastic bones of children and young adults this device is not worth the time required to use it in the operation.

6. The operation of choice would appear to be the removal of a simple cylinder of bone of proper length and the fixation of the approximated fragments by a bone splint or Lane plate.

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