Femoral Lengthening: How Far Can We Go?
R. GILLESPIE, S. HUBBARD AND L. HAMILTON***Toronto, Ontario
Considerable controversy exists over the appropriate goals and objectives to be established in the management of the extremely short femur. Two cases of congenital short femur were managed by Wagner leg lengthening.
Although the child was referred for management of PFFD, after initial assessment the diagnosis was changed to congenitally short femur, with the length being 40 percent of the contralateral side. Treatment consisted of two femoral lengthenings, valgus osteotomy of the ipsilateral hip and epiphyseodesis of the contralateral distal femur. Follow-up at age 14 demonstrated that the leg equalization was within 2 cm of the opposite side. This case illustrates that the femoral lengthening can be extensive. The predicted joint-length discrepancy of 18 cm was almost completely equalized.
Admitting diagnosis was congenitally short femur with fibular hemimelia. The final predicted leg-length discrepancy was 18 cm. Surgical management consisted of femoral lengthening, tibial lengthening and contralateral epiphyseodesis of the distal femoral condyle. The final result was a leg length within 2 cm of the normal side.
The cases illustrate that surgical equalization of extreme leg-length discrepancies is feasible even with length greater than 15 cm. The successes are not won without complications. The second case incurred dislocation of the knee. The complications and pitfalls will be discussed from the perspective of realistic goal setting.
***The Hugh MacMillan Medical Centre (OCCC), 350 Rumsey Road, Toronto, Ontario, M4G 1R8, Canada