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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 7, 962-967.
doi: 10.1302/0301-620X.91B7.21304  
Copyright © 2009 by British Editorial Society of Bone and Joint Surgery
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Lengthening of the congenital short femur using the Ilizarov technique

A SINGLE-SURGEON SERIES

W. J. S. Aston, BSc, FRCSEd(Trauma & Orth), Specialist Registrar1; P. R. Calder, FRCS(Trauma & Orth), Paediatric Orthopaedic Fellow1; D. Baker, BSc(Hons), FRCS(Trauma & Orth), Paediatric Orthopaedic Fellow1; J. Hartley, MSc, MCSP, Clinical Specialist Physiotherapist (Paediatric Orthopaedics)1; and R. A. Hill, BSc, FRCS, Consultant Orthopaedic Surgeon1

1 Hospital for Sick Children, Great Ormond Street, London WC1N 3JH, UK.

Correspondence should be sent to Mr W. J. S. Aston; e-mail: willaston1{at}googlemail.com

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° to 124.2° (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.




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[Abstract] [Full Text] [PDF]


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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General