Case 28: Congenital Femoral Deficiency, Type 1A

Four year-old patient with congenital femoral deficiency, type 1A. He has a 12.5 cm (~5 inches) limb length discrepancy.

We performed hip correction surgery including a pelvic osteotomy in order to address the hip deformity and deficiency prior to lengthening.

At six years old, patient underwent first limb lengthening, with application of the external fixator to the femur. Follow up during lengthening shows excellent bone regenerate.

Patient gained over 5 cm of length and the external fixator was removed. The remaining limb length discrepancy was down to 6 cm.  Patient displays excellent range of motion of the hip and knee.

At ten years of age patient underwent second limb lengthening with application of the modular rail system (MRS) external fixator to the femur. The fixator extended to the tibia in order to protect the knee joint. Patient gained 8 cm of length. The external fixator was removed after consolidation and a rush rod inserted into the femur.

At age thirteen, patient had an epiphysiodesis on the affected side. This will give him 5 cm of additional length. At age sixteen, patient underwent third lengthening with internal lengthening nail.

At age nineteen patient underwent fourth and final lengthening with internal nail. He has achieved a total length gain of 30 cm (12 inches) throughout his life. This includes four femoral lengthenings (2 with external fixator, 2 with internal fixator) and one epiphysiodesis.

At 20 years old, patient has a fully functional left leg. He has equal limb length and no residual deformity. During his last follow up he was playing basketball at Dr. Paley's house with another patient who is also of equal leg length.

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