Femoral neck fracture following leg lengthening by callotasis

Abstract

A 27-year-old man had 4.5 cm of true shortening of his left leg following a fracture of his femur 10 years previously. Leg lengthening was performed using the technique of callotasis (De Bastiani et al., 1987) at a diaphyseal osteotomy. Lengthening began 3 weeks postoperatively at 1 mm per day in four increments. After the desired lengthening had been achieved the patient was encouraged to walk bearing partial weight with crutches. Sixteen weeks after lengthening had been discontinued the regenerate appeared to be consolidating satisfactorily. However the patient complained of recent, gradually worsening pain in the left hip. No significant injury had been sustained. Radiographs revealed a displaced subcapital fracture of the left hip (Figure I). This was treated by removal of the fixator and, when the pin tracks had healed, by open reduction and internal fixation of the fracture with cannulated hip screws. After 18 months follow-up the femoral neck fractures united satisfactorily and there was no evidence of avascular necrosis.