title: Lower limb inequality treatment with subtrochanteric femoral shortening osteotomy fixed with intramedullary nail.
abstract: BACKGROUND
  The aim of the study is to analyze the results of treating the lower limb inequality with subtrochanteric femoral shortening osteotomy fixed with interlocking intramedullary nail. The analyzed material includes 14 patients aged 16 to 36 (mean 25), in whom femoral shortening osteotomy fixed with interlocking nail was performed. In all patients the indication for this therapeutic method was lower limb inequality caused by femur shortening and accompanied by contraindication for femoral lengthening procedure. Limb length inequality ranged from 1.5 to 6.0 cm (mean 3.8). The follow-up period was between 2 and 6 years (mean 3.8).
  
  
  METHODS
  All patients underwent open subtrochanteric femoral osteotomy with interlocking intramedullary nail fixation. The amount of bone resected from the femoral subtrochanteric area ranged from 1.5 to 4.5 cm (mean 3.3). Dynamization of the nail (removal of one or two peripheral interlocking screws) was performed in 11 patients.
  
  
  RESULTS
  In all patients the expected limb shortening was achieved. Osteotomy site union was observed in 8 out of 14 patients 3.5 to 6 months (mean 4.8) after the surgery. In 3 patients delayed union was observed after 10-12 months (mean 11). In other 3 patients the lack of union did not cause any major problems, but it required additional surgical intervention (Judet-Forbes procedure, PRP administration). Following the procedure the union was observed after 30, 31 and 60 months respectively.
  
  
  CONCLUSIONS
  Subtrochanteric femoral shortening osteotomy fixed with interlocking intramedullary nail is a good alternative method in lower limb inequality treatment in the adult patients in whom the Ilizarov method is contraindicated. Few complications such as delayed union are well tolerated due to intramedullary fixation, and only some of them may require secondary surgical intervention.
authors.affiliation: Department of Pediatric Orthopedics and Traumatology, Poznań University of Medical Sciences, Poznań, Poland. pawel.koczewski@gmail.com
authors.forename: Paweł
authors.initials: P
authors.lastname: Koczewski
authors.forename: Milud
authors.initials: M
authors.lastname: Shadi
mesh_terms: D000293:Adolescent; D000328:Adult; D001852:Bone Lengthening / Q000379:methods*; D001858:Bone Nails; D016267:External Fixators; D005260:Female; D005269:Femur / Q000601:surgery*; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D006801:Humans; D007870:Leg Length Inequality / Q000601:surgery*; D016059:Range of Motion, Articular; D016896:Treatment Outcome; D055815:Young Adult