Surgical Treatment of an Infected Nonunion of the Middle Third of the Femur Associated with Femoral Shortening in a Hemophilia Patient

The management of nonunion and limb length discrepancy has remained a constant challenge in hemophilic patients. In this study, we aimed to present the treatment of femur infected nonunion and limb length discrepancy in a twenty-seven-year-old patient with hemophilia type A. A 27-year-old male patient with hemophilia type A referred to our institution for the treatment of right femur infected nonunion and 10 cm shortness of the femur. Resection of the nonunion site and bone-to-bone fixation with autologous bone grafting were performed. Compression to the pseudoarthrosis site and distraction from new osteotomy site were applied with the unilateral external fixator. Union was achieved, and 6 cm lengthening was obtained according to the initial length. Patient was followed up for 7 years. After this treatment, the patient is able to walk with full weight bearing on the affected extremity with 4 cm shortening which is compensated by the heel lift. The results of this case indicate that limb lengthening and treatment of nonunion with the external fixation could be reliable and effective method for hemophilic patients.

Download Full-text

Intramedullary Bone Lengthening Following Preceding Hip Surgery—A Case Series

Journal of Clinical Medicine ◽

10.3390/jcm9124104 ◽

2020 ◽

Vol 9 (12) ◽

pp. 4104

Author(s):

Lukas Zak ◽

Thomas Manfred Tiefenboeck ◽

Gerald Eliot Wozasek

Keyword(s):

Hip Dysplasia ◽

Young Patients ◽

Limb Lengthening ◽

Limb Length Discrepancy ◽

Limb Length ◽

Hip Surgery ◽

Bone Lengthening ◽

Safe Procedure ◽

Length Discrepancy ◽

Healing Index

Limb length discrepancy (LLD) is a common problem after joint-preserving hip surgeries, hip dysplasia, and hip deformities. Limping, pain, sciatica, paresthesia, and hip instability are common clinical findings and may necessitate limb-lengthening procedures. The study included five patients (two female and three male, mean age of 28 years (20–49; SD: 12)) with symptomatic limb length discrepancy greater than 2.5 cm (mean: 3.6 cm) after total hip arthroplasty (THA), hip dysplasia, or post-traumatic hip surgery. They underwent either ipsi- or contralateral intramedullary limb-lengthening surgeries using the PRECICE™ telescopic nail. All patients achieved complete bone healing and correction of the pelvic obliquity after intramedullary lengthening. None of the patients had a loss of proximal or distal joint motion. The mean distraction-consolidation time (DCT) was 3.8 months, the distraction index (DI) 0.7 mm/day, the lengthening index (LI) 1.8 months/cm, the consolidation index (CI) 49.2 days/cm, the healing index (HI) 1.1 months/cm, and the modified healing index (HI*) 34 days/cm. Intramedullary limb lengthening after LLD in cases of hip dysplasia, hip deformity, and various kinds of hip surgery is a useful and safe procedure in young patients to achieve equal limb length. No functional impairment of the preceded hip surgery was seen.

Download Full-text

Limb lengthening in Africa: tibial lengthening indicated for limb length discrepancy and postosteomyelitis pseudarthrosis

Orthopedic Research and Reviews ◽

10.2147/orr.s61577 ◽

2014 ◽

pp. 67

Author(s):

Farikou Ibrahima ◽

Pius Fokam ◽

Faustin Mouafo Tambo

Keyword(s):

Limb Lengthening ◽

Limb Length Discrepancy ◽

Limb Length ◽

Tibial Lengthening ◽

Length Discrepancy

Download Full-text

Two-stage total hip arthroplasty following skeletal traction after extensive soft tissue release for severe limb-length discrepancy

Hip International ◽

10.1177/1120700019865742 ◽

2019 ◽

pp. 112070001986574

Author(s):

Soong Joon Lee ◽

Kang Sup Yoon

Keyword(s):

Soft Tissue ◽

Total Hip Arthroplasty ◽

Limb Lengthening ◽

Limb Length Discrepancy ◽

Neurological Complications ◽

Limb Length ◽

Soft Tissue Release ◽

Skeletal Traction ◽

Length Discrepancy ◽

Shortening Osteotomy

Introduction: To maximise limb-length discrepancy (LLD) resolution during total hip arthroplasty (THA) for untreated developmental hip dysplasia or septic hip sequelae, THA following limb lengthening was introduced using different methods. We aimed to evaluate 2-stage THA results following limb lengthening via skeletal traction after extensive soft tissue release. Method: In total, 24 hips with severe LLD in 10 men and 14 women (mean age, 49.6 ± 15.2 years) underwent 2-stage THA and were followed thereafter (mean 6.3 ± 3.7 years). The entire abductor muscle origin was subperiosteally released from the ilium, and the soft tissue around the hip joint, including the psoas tendon, short external rotator, joint capsule, and adductor tendon, was extensively released. 2-stage THA was performed after 2-week skeletal traction using proximal tibial pins. During the final THA, 7 hips necessitated subtrochanteric shortening osteotomy (STO) for hip joint reduction. We evaluated the clinical and radiological results and especially focused on LLD and neurological complications. Results: The Harris Hip Score improved from 57.1 ± 9.6 to 88.3 ± 6.3 points. No patients showed worse abductor power. LLD improved from 5.0 ± 2.0 to 1.4 ± 1.0 cm. No permanent neurological complications occurred except for 1 transient peroneal nerve palsy during traction, which resolved fully after cessation of traction. There were 2 hips with STO nonunion treated with osteosynthesis and stem revision. Conclusion: 2-stage THA following skeletal traction after extensive soft tissue release showed favourable results in terms of neurologic complication prevention and LLD resolution. However, a large proportion of patients still necessitated shortening osteotomy with a risk for nonunion at the osteotomy site. Though surgical procedures might be complicated and necessitate longer hospital stays, 2-stage THA with extensive soft tissue release might be an alternative treatment option for patients with severe LLD willing to resolve their limb length discrepancy.

Download Full-text

Trans-osseous intraoperative limb length measurement in hip replacement surgery

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20204594 ◽

2020 ◽

Vol 6 (6) ◽

pp. 1258

Author(s):

Anoop Pilar ◽

Srivatsa Nagaraj Rao ◽

Madan Mohan Muniswamy ◽

Sandesh G Manohar ◽

Rajkumar S. Amaravathi

Keyword(s):

Hip Replacement ◽

Intraoperative Imaging ◽

Weight Bearing ◽

Limb Length Discrepancy ◽

Limb Length ◽

Harris Hip Score ◽

Posterior View ◽

Replacement Surgery ◽

Hip Replacement Surgery ◽

Length Discrepancy

Background: Discrepancy of the limb length following total hip replacement is one of common complication. To reduce the occurrence, various modalities are used like pre-operative templating, navigation assisted measurements and intraoperative methods. This study was done using trans-osseous method of measurement using hip gauge which provides a faster, simpler assessment of limb length.Methods: A prospective study of 25 patients who underwent uncemented hip arthroplasty was taken in the study and the LLD was measured before and after the surgical procedure. Patient were re-assessed for limb length discrepancy after 6 months with functional Harris hip score and radiological analysis on weight bearing standard X-ray antero-posterior view of the pelvis with bilateral hip joint.Results: The results showed significant improvement in limb length discrepancy, and analysis of postoperative radiographs found the mean length difference of 2.44 mm and average Harris hip score was 95.5. No device related complications were reported, and none of them complained of the discomfort related to limb-length discrepancy after surgery. Conclusions: Trans-osseous fixed method using hip gauge provides a faster, reproducible and simpler method for the assessment of Limb length and aids with offset placement, acetabular anteversion for precise cup placement. This is a reliable method as it can be used both in the primary and revision hip surgery and most importantly doesn’t require any additional intraoperative imaging.

Download Full-text

Use of a Magnetic Bone Nail for Lengthening of the Femur and Tibia

Journal of Orthopaedic Surgery ◽

10.1177/1602400321 ◽

2016 ◽

Vol 24 (3) ◽

pp. 374-378 ◽

Cited By ~ 8

Author(s):

Ozgur Karakoyun ◽

Sami Sokucu ◽

Mehmet Fatih Erol ◽

Metin Kucukkaya ◽

Yavuz Selim Kabukcuoglu

Keyword(s):

Weight Bearing ◽

Limb Lengthening ◽

Limb Length Discrepancy ◽

Full Weight Bearing ◽

Angular Correction ◽

Consolidation Phase ◽

The Mean ◽

Maturation Index ◽

Ellis Van Creveld Syndrome ◽

Bone Nail

Purpose To report our experience with the PRECICE nail for limb lengthening in 23 patients. Methods Records of 15 female and 8 male patients aged 14 to 38 (mean, 23.6) years who underwent lengthening of the tibia (n=6) or femur (n=21) using the PRECICE nail were reviewed. The reasons for lengthening included trauma (n=7), hemihypertrophy (n=2), focal femoral deficiency (n=2), Ellis-van Creveld syndrome (n=1), hip septic arthritis sequelae (n=1), hereditary multiple exostosis (n=1), club foot sequela (n=1), congenital tibial pseudoarthrosis (n=1), fibrous dysplasia (n=1), idiopathic limb length discrepancy (n=7), and cosmetic (n=1). Results The mean follow-up duration was 20.72 months. The mean lengthening was 48.20 mm, and the mean acute angular correction was 15.5°. The mean time to full weight-bearing was 5.15 months, and the mean consolidation index was 1.12 months/cm. The mean maturation index was 0.78 months/cm. One patient had nail breakage during the consolidation phase. The nail was replaced by an intramedullary nail until consolidation, after which another PRECICE nail was used to treat the residual shortening. Eight patients had over-lengthening and the nails were driven back to the desired length. No patient had infection. Conclusion The PRECICE nail is a viable option for lengthening of the femur and tibia.

Download Full-text