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Does Leg Lengthening Pose a Threat to a Child’s Mental Health?: An Interim Report one year after surgery
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
2007 (English)In: Journal of Pediatric Orthopaedics, ISSN 0271-6798, E-ISSN 1539-2570, Vol. 27, no 6, 611-617 p.Article in journal (Refereed) Published
Abstract [en]

Previous studies suggest that children react with functional and psychological disturbances after leg lengthening (LL). Long-term effects are not known, and there is a lack of prospective studies. The aim of this interim prospective study was to investigate the psychological impact of the Ilizarov technique on a sample of children 1 year after surgery. Methods: The subjects were 27 patients aged 6 to 16 years treated using the Ilizarov technique at the Pediatric Orthopaedic Department, Uppsala University Hospital, between 1997 and 2005. A control group of healthy children matched for age and sex were also included. Semistructured interviews and psychometric measures (anxiety, depression, self-esteem, behavior) were administered to patients and parents before surgery and 1 year after. Psychological measures were correlated with medical records (days of hospitalization, gained length, etc). The control group was examined at initial assessment only. Results: Before reconstructive surgery, the LL group had a significantly lower self-esteem compared with the control group. Aggressive behavior, attention and externalization problems, anxiety, and depression were significantly reduced after LL. Parents' state anxiety was also reduced. There were no differences in trait anxiety between the parents of patients and the parents of the control children. Conclusions: Patients reported pain, psychological discomfort, complications, and restrained function during LL. However, there were no adverse psychological effects at 1-year follow-up; rather, there were signs of improved mental health. No single psychological parameter could predict the outcome after LL.

Place, publisher, year, edition, pages
2007. Vol. 27, no 6, 611-617 p.
Keyword [en]
Human, Treatment, Surgery, Mental health, Child, Leg, Surgical lengthening
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-97927DOI: 10.1097/BPO.0b013e31814256c6ISI: 000255766500003PubMedID: 17717458OAI: oai:DiVA.org:uu-97927DiVA: diva2:173050
Available from: 2009-01-23 Created: 2009-01-23 Last updated: 2013-01-17Bibliographically approved
In thesis
1. Mental Health in Children Undergoing Reconstructive Surgery: Studies on Self-Esteem and Social Interaction
Open this publication in new window or tab >>Mental Health in Children Undergoing Reconstructive Surgery: Studies on Self-Esteem and Social Interaction
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

While the functional and anatomical aspects of reconstructive surgery in children with leg length inequality (LLI), prominent ears (PE) and cleft lip and palate (CLP) have been studied in detail, the psychological aspects of surgery have been less explored. The benefit of a changed appearance and function on self-esteem and ability to social interaction are other areas where information is lacking. The aim of this thesis is to examine, during the process of reconstructive surgery, the mental health, self-esteem and social interaction of children with defects in appearance and function.

Children, aged 6-16 years, with LLI (n=27) and PE (n=31) were invited to participate in interviews and psychological assessments by filling in a battery of questionnaires and tests (depression; anxiety; self-esteem; cognitive ability; and behaviour) before Ilizarov and otoplasty surgery and one year after. Parents filled in a child symptom check list and a state and trait anxiety questionnaire. Another six adolescents with CLP and their parents participated in interactive interviews with the aim of identifying relevant psychological issues for individuals with this condition. These issues were subsequently used to create new questionnaires. Being different, the development of self-esteem and social interaction were the central themes of the questionnaires designed after the interview study. The new questionnaires were explored in a retrospective study on other adolescents (n=26) with CL/P and their parents. Beck’s Youth Inventories (BYI) was used as comparative data.

The LLI group had significantly lower mental health and self-esteem scores than the control group before surgery. The leisure activity level in both patient groups was low according to parents’ report before surgery. The mental health scores of both patient groups (LLI and PE) were improved after reconstructive surgery, but self-esteem was not affected.

The questionnaires for CL/P patients proved to be useful in the exploration of self-esteem from a developmental perspective and in the search for strengthening factors of social interaction. Self-esteem was average or high on group level for adolescents with CL/P compared to BYI measure. Parents rated their adolescents to have higher self-esteem than the adolescents themselves. Females had a less positive development of self-esteem, there was an interaction effect between the female and male patients’ evaluation of self-esteem by higher age.

Even a minor appearance defect like PE may affect mental health negatively. There were no adverse psychological effects one year after surgery in LLI and PE patients, rather, there were signs of improved mental health. Adolescents with CL/P have an anticipated risk of more mental health problems and especially those individuals who have been bullied. Cleft teams and Child and Adolescent Psychiatric Clinics should be attentive and offer psychological support to those individuals most affected by their conditions.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2008. 65 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 408
National Category
urn:nbn:se:uu:diva-9510 (URN)978-91-554-7376-1 (ISBN)
Public defence
2009-01-15, Auditoriet, Gustavianum, 75310, Uppsala, 13:15
Available from: 2009-01-23 Created: 2009-01-23Bibliographically approved

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