Combined antegrade femur lengthening and distal deformity correction: a case series

Achraf Jardaly,Shawn R Gilbert

doi:10.1186/s13018-020-02168-6

Abstract

BackgroundLeg length discrepancy is often associated with distal femur angular deformities such as valgus or flexion. This study aims to report a new technique for simultaneous limb lengthening and acute distal femoral angular correction.MethodsA retrospective chart review of patients undergoing a single procedure was conducted. Patients included had a single operation where they underwent distal femur osteotomy stabilized with a plate followed by antegrade nailing with a magnetically controlled intramedullary lengthening nail (PRECICE, Ellipse Technologies, Inc., Irvine, CA, USA) using a trochanteric entry.ResultsSeven femurs from 7 patients were included. The average age at operation was 13.6 years, and the leg length difference was 51 mm (range 30–105 mm). Associated deformities were valgus (4), knee flexion contracture (2), and both valgus and flexion contracture (1). Lengthening achieved was 43 mm (P = 0.0036), with a consolidation index of 27 days/cm and reliability of 0.87 (6/7). The 5 patients with angulation had an improvement of valgus from 12 to 4° (P = 0.006) and of the mechanical axis deviation from 34 to 3 mm (P = 0.0001). The range of motion also improved in the 3 patients with contractures. Preoperative gait disturbance, hip and knee pain, and functional scoliosis resolved after the limb deformities were corrected.ConclusionCombining a magnetic internal lengthening nail with a second distal osteotomy stabilized with a plate can successfully correct limb length and distal femur deformity acutely without altering the expected result of each procedure.

Highlights

Leg length discrepancy is often associated with distal femur angular deformities such as valgus or flexion
While a variety of conservative and operative options exists, limb lengthening procedures are increasingly preferred due to technical advances and patient preference [2]. These procedures have drastically changed with the advent of intramedullary lengthening rods
To avoid complications associated with this technique, here, we report our experience with a less common approach in the correction of different distal femur angular deformities accompanying leg length difference (LLD): antegrade nailing and the use of a distal femoral osteotomy (DFO) stabilized with a plate [18]

Summary

Introduction

Leg length discrepancy is often associated with distal femur angular deformities such as valgus or flexion. Abnormalities in the femur and tibia are the leading cause of leg length difference (LLD). These abnormalities commonly stem from congenital, infectious, or traumatic conditions [1]. While a variety of conservative and operative options exists, limb lengthening procedures are increasingly preferred due to technical advances and patient preference [2]. These procedures have drastically changed with the advent of intramedullary lengthening rods. Magnetic intramedullary nails offer the most accurate distraction and precise lengthening [1, 2, 4, 6,7,8,9,10,11]

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