title: [Lengthening of proximal femoral focal deficiency using a hybrid fixation with inclusion of the knee joint].
abstract: BACKGROUND
  A major problem in lengthening a short femur in proximal focal deficiency of the femur (PFFD) is the development of contractures and dislocation of the hip and knee joint. The knee joint is particularly prone to dislocation because of the cruciate ligament insufficiency associated with PFFD. Axis deviations also need specific attention.
  
  
  METHODS
  In four patients (age 2.5-11 years) with PFFD (PAPPAS class III in one patient and VII in three patients), five femoral lengthenings with mechanical axis corrections were performed by the callotasis technique using a hybrid fixation system (Monotube/Triax) connecting the femur and the tibia with a fixed hinged knee joint to protect the knee against contracture and dislocation.
  
  
  RESULTS
  All patients retained their hip and knee function. Hip flexion contracture during lengthening may make inclusion of the hip joint into the fixation system necessary, but was not carried out in the four patients presented.
  
  
  CONCLUSIONS
  Four consecutive lengthenings of the femur with focal deficiency were carried out under protection by a hinged knee bridging external fixator. A dislocation could be prevented in all patients. We consider that such a system could be used during these lengthening procedures.
authors: Orthopädische Universitätsklinik Zürich, Balgrist, Forchstr. 340, 8008 Zürich. Leonhard.ramseier@balgrist.ch
authors: L E
authors: LE
authors: Ramseier
authors: G U
authors: GU
authors: Exner
mesh_terms: D001852:Bone Lengthening / Q000295:instrumentation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D016267:External Fixators; D005260:Female; D005269:Femur / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000517:prevention & control; D031221:Knee Dislocation / Q000517:prevention & control*; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000502:physiology; D007870:Leg Length Inequality / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D011859:Radiography; D013997:Time Factors; D016896:Treatment Outcome