Lengthening of the congenital short femur using the Ilizarov technique: a single-surgeon series.
We present a retrospective review of a single-surgeon series of 30 consecutive lengthenings in 27 patients with congenital short femur using the Ilizarov technique performed between 1994 and 2005. The mean increase in length was 5.8 cm/18.65% (3.3 to 10.4, 9.7% to 48.8%), with a mean time in the frame of 223 days (75 to 363). By changing from a distal to a proximal osteotomy for lengthening, the mean range of knee movement was significantly increased from 98.1 degrees to 124.2 degrees (p = 0.041) and there was a trend towards a reduced requirement for quadricepsplasty, although this was not statistically significant (p = 0.07). The overall incidence of regenerate deformation or fracture requiring open reduction and internal fixation was similar in the distal and proximal osteotomy groups (56.7% and 53.8%, respectively). However, in the proximal osteotomy group, pre-placement of a Rush nail reduced this rate from 100% without a nail to 0% with a nail (p < 0.001). When comparing a distal osteotomy with a proximal one over a Rush nail for lengthening, there was a significant decrease in fracture rate from 58.8% to 0% (p = 0.043). We recommend that in this group of patients lengthening of the femur with an Ilizarov construct be carried out through a proximal osteotomy over a Rush nail. Lengthening should also be limited to a maximum of 6 cm during one treatment, or 20% of the original length of the femur, in order to reduce the risk of complications.
Aston
W J S
WJ
Hospital for Sick Children, Great Ormond Street, London WC1N 3JH, UK. willaston1@googlemail.com
Calder
P R
PR
Baker
D
D
Hartley
J
J
Hill
R A
RA
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005269:Femur / Q000002:abnormalities / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D018889:Ilizarov Technique; D007870:Leg Length Inequality / Q000151:congenital / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D010027:Osteotomy / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome