Abstract
BackgroundLimb length discrepancy (LLD) in the setting of concurrent hindfoot and ankle deformity poses an added level of complexity to the reconstructive surgeon. Regardless of etiology, a clinically significant LLD poses additional challenges without a forthright and validated solution. The purpose of the current study is to determine whether reconstructive hindfoot and ankle surgery with concurrent lengthening through a distal tibial corticotomy is comparable to other treatment alternatives in the literature.Patients and methodsA retrospective review of hindfoot and ankle deformity correction utilizing Ilizarov circular external fixation with concurrent distal tibial distraction osteogenesis from July 2009 to September 2014 was conducted.ResultsThis study included 19 patients with a mean age of 47.47 ± 13.36 years with a mean follow up of 576.13 ± 341.89 days. The mean preoperative LLD was 2.70 ± 1.22 cm and the mean operatively induced LLD was 2.53 ± 0.59 cm. The mean latency period was 9.33 ± 3.47 days and distraction rate was 0.55 ± 0.16 mm/day. The mean distraction length was 2.14 ± 0.83 cm and mean duration of external fixation was 146.42 ± 58.69 days. The time to union of all hindfoot and ankle fusions was 121.00 ± 25.66 days with an overall fusion rate of 85.71%.ConclusionsThe successful treatment of hindfoot and ankle deformity correction in the setting of LLD using the technique of a distal tibial corticotomy and distraction osteogenesis is reported and illustrates an additional treatment technique with comparable measured outcomes to those previously described. We urge that each patient presentation be evaluated with consideration of all described approaches and associated literature to determine the current best reconstructive approach as future studies may validate or replace the accepted options at present.
Highlights
Limb length discrepancy (LLD) in the setting of concurrent hindfoot and ankle deformity poses an added level of complexity to the reconstructive surgeon
Orthopedic pathology affecting the hindfoot and ankle can be debilitating to the ambulatory patient, especially when accompanied by limb length discrepancy (LLD)
Patients with a broad array of diagnoses may be categorized as having hindfoot and ankle deformity with accompanying LLD, these include talar avascular necrosis (AVN), failed total ankle replacement (TAR), congenital or post-traumatic LLD, and those with unintended sequela of surgical interventions or failed hindfoot and ankle reconstructive attempts, e.g., nonunion and/or malunion
Summary
Limb length discrepancy (LLD) in the setting of concurrent hindfoot and ankle deformity poses an added level of complexity to the reconstructive surgeon. While it has been suggested that a LLD greater than 2– 2.5 cm is poorly tolerated [5], a LLD of 0.5–1 cm is perhaps desirable in situations of preexisting or concurrent hindfoot fusions [6]. It has, been reported that as little as a 3-mm LLD can cause postural changes, which over time, may lead to degenerative changes and adaptations of the kinetic chain [7,8,9,10]. Deficient limb lengths not amenable to conservative management may require surgical intervention
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