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Fragomen AT, Fragomen FR. Distal femoral flexion deformity from growth disturbance treated with a two-level osteotomy and internal lengthening nail. Strategies Trauma Limb Reconstr. 2017;12(3):159-167doi: 10.1007/s11751-017-0298-2.
Fragomen, A. T., & Fragomen, F. R. (2017). Distal femoral flexion deformity from growth disturbance treated with a two-level osteotomy and internal lengthening nail. Strategies in trauma and limb reconstruction, 12(3), 159-167. https://doi.org/10.1007/s11751-017-0298-2
Fragomen, Austin T, and Fragomen, Fiona R. "Distal femoral flexion deformity from growth disturbance treated with a two-level osteotomy and internal lengthening nail." Strategies in trauma and limb reconstruction vol. 12,3 (2017): 159-167. doi: https://doi.org/10.1007/s11751-017-0298-2
Fragomen AT, Fragomen FR. Distal femoral flexion deformity from growth disturbance treated with a two-level osteotomy and internal lengthening nail. Strategies Trauma Limb Reconstr. 2017 Nov;12(3):159-167. doi: 10.1007/s11751-017-0298-2. Epub 2017 Oct 16. PMID: 29039128; PMCID: PMC5653604.
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Strategies Trauma Limb Reconstr. 2017 Nov;12(3):159-167. doi: 10.1007/s11751-017-0298-2. Epub 2017 Oct 16.

Distal femoral flexion deformity from growth disturbance treated with a two-level osteotomy and internal lengthening nail.

Strategies in trauma and limb reconstruction

Austin T Fragomen, Fiona R Fragomen

Affiliations

  1. Weill Medical College, Cornell University, 535 East 70th Street, New York, NY, 10021, USA. [email protected].
  2. Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA. [email protected].
  3. Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.

PMID: 29039128 PMCID: PMC5653604 DOI: 10.1007/s11751-017-0298-2

Abstract

Salter Harris fractures of the distal femur can lead to growth disturbance with resulting leg length inequality and knee deformity. We have looked at a case series (3) of patients who presented with a distal femur flexion malunion and shortening treated with a distal femoral osteotomy and plating and a proximal femoral osteotomy with a magnetic internal lengthening nail. Does a two-level osteotomy and internal fixation approach provide a reliable result both radiographically and functionally? The average knee extension loss was 12°, LLD 47 mm, PDFA 65°, MAD 2 mm. The patients were treated with an acute, posterior, opening wedge osteotomy of the distal femur stabilized with a lateral plate and screws and grafted with cancellous chips and putty. A second osteotomy was made proximally in the femur percutaneously, and the internal lengthening nail was inserted. Lengthening was done at approximately 1 mm/day. The average extension gain was 12°; amount of lengthening at the proximal site was 40 mm, LLD was 3 mm. The average PDFA was 81°, and MAD 3 mm. There were no complications. Functional results were excellent. Bone healing index was 24 days/cm. The average distance from the distal osteotomy to the joint line was 57 mm. The technique of two-level femur osteotomy stabilized with a plate and lengthening nail yielded excellent results with acceptable correction of deformity, full knee extension, and improved function. There were no complications including implant failure, infection, need for blood transfusion, knee stiffness, nonunion, compartment syndrome, or malunion.

Keywords: Deformity; Limb lengthening; Magnetic internal lengthening nail; Osteotomy; Precice; TomoFix

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