Proximal Femoral Focal Deficiency
LEON M. KRUGER, MD
Four types of PFFD described by Aitkin are discussed and identified individually by clinical and x-ray findings. Management of the hip by osteotomy or osteosynthesis to obtain a reasonable neck/shaft angle surgically is quite important in Types A and B. In Types C and D, we do not advise surgery at the hip level.
For children with unilateral PFFD, knee fusion in full extension prior to amputation and prosthetic restoration is recommended. In contrast, the patient with bilateral symmetry is usually best left with the feet intact, but can be fitted with stilt-type prostheses to regain height comparable to that of the child's peers. Those with asymmetrical PFFD will require a unilateral orthoprosthesis, or amputation and prosthesis, in order to equalize leg lengths. The patient with asymmetry can also be fitted with bilateral stilt-type prostheses.
Shriners Hospital for Crippled Children, 516 Carew Street, Springfield, MA 01104