|Beitragstitel||Lengthening Of A Posttraumatic Leg Length Discrepancy Of 23 Cm By Distraction Osteogenesis Of The Femur – A Case Report|
We present the case of a posttraumatic leg length discrepancy of 23cm with severe deformity of the femur, knee and the tibia, which was treated by knee arthrodesis followed by distraction osteogenesis.
Intramedullary motorized lengthening devices allow reducing problems associated with external fixators in distraction osteogenesis, such as pintract infections, reduced range of motion of adjacent joints, lack of tolerance by the patient and fracture risk after removal of the fixator.
The 27 year old male patient suffered from a severe, posttraumatic leg length discrepancy and a deformity of the knee after a car accident at the age of 6 years. The knee had a flexion contracture of 30° with posterior subluxation of the proximal tibia and a valgus of 10°. Compared to the contralateral side, the femur was shortened by 18cm and the tibia by 5cm.
First a knee arthrodesis was performed using an antegrade intramedullary nail (Stryker T2). The procedure was complicated by a compartment syndrome of the lower leg, which required several soft tissue procedures and resulted in residual neurological deficits of the foot. After 10 months and radiological fusion of the knee, the magnetic driven intramedullary PRECICE nail was implanted and the femoral corticotomy done. Uncomplicated distraction osteogenesis followed with 0,25-0,5mm lengthening/day. 4 months later, when the maximum length allowed by the device was reached, the nail was exchanged to a new PRECICE nail, with which a total lengthening of 16 cm was achieved. Due to the fixed equinus of the foot, functionally the patient has achieved full leg length equalization 8 months after the last procedure and 24 months after the index procedure. Ambulation without canes or residual pain was possible 2 months later.
In this case of a complex posttraumatic deformity with severe soft tissue damage of the lower limb and incapacitating leg length discrepancy of 20cm a good resultat and lengthening of 16cm was achieved using the fully inserted PRECICE nail avoiding the soft tissue problems, which precluded in this patient an external device.