Percutaneous femoral shortening over a nail using on-site smashing osteotomy technique.

Abstract

Closed femoral-shortening osteotomy over an intramedullary nail for the treatment of leg length discrepancy (LLD) is a demanding surgical technique, classically requiring specialized instrumentation (intramedullary saw and chisel). Herein, we describe our experience with shortening osteotomy over a nail, using a percutaneous multiple drill-hole osteotomy technique to perform the bone section with the osteotomized bone smashed and let on-site. We operated on six patients with LLD due to: hemihypertrophy syndrome (three patients), congenital short femur, hemiplegic cerebral palsy, and growth plate injury. Mean femoral shortening was 4.2cm. Osteotomy was performed via a multiple drill-hole technique, and femurs were stabilized using an intramedullary nail. Post-operative clinical and radiological data were recorded. Residual LLD was assessed through long-standing teleroentgenography. Shortening was achieved, with a final LLD of < 1cm in all patients. All patients were satisfied and considered the lengths of the lower limbs to be equal. Our technique did not require special surgical skill or specialized instrumentation. Moreover, we did not record intraoperative and post-operative complications. Percutaneous femoral-shortening osteotomy over a nail using the on-site smashing osteotomy technique was effective and safe in treating LLD in this initial case series.