treatment of congenital femoral shortening with coxa vara 김용욱 김용욱 정형외과 yong u...

Treatment of Congenital Femoral Treatment of Congenital Femoral Shortening Shortening

with Coxa Varawith Coxa Vara

김용욱 김용욱 김용욱 정형외과김용욱 정형외과

Yong U KimYong U KimDr.Kim’s Orthopaedic ClinicDr.Kim’s Orthopaedic Clinic

CC: Limping gait and Leg CC: Limping gait and Leg length discrepancylength discrepancy10years and 10 months 10years and 10 months old ,maleold ,male

CC: Limping Gait and Leg CC: Limping Gait and Leg Length DiscrepancyLength Discrepancy10years and 10 months old ,male10years and 10 months old ,male

Coxa Vara + 5.7 cm. Shortening.Coxa Vara + 5.7 cm. Shortening.

TasksTasks

• Elimination of Trendelenburg type limping gElimination of Trendelenburg type limping gaitait

• Equalize leg length discrepancyEqualize leg length discrepancy• Prevent possible further progress of deforPrevent possible further progress of defor

mitymity

Solving the Problems of Solving the Problems of Coxa Vara and Shortening of FemurCoxa Vara and Shortening of Femur

PlanPlan

• 2 Staged Surgeries2 Staged Surgeries• 11stst : Femoral Lengthening : Femoral Lengthening• 22ndnd :Correction of Coxa Vara + Lengthening :Correction of Coxa Vara + Lengthening

if neededif needed

11stst Stage Op:Femoral Lengthening Stage Op:Femoral Lengthening

• Lengthening with IlizarLengthening with Ilizarov External Fixaterov External Fixater

Femoral Lengthening MidphaseFemoral Lengthening Midphase

4.74.7 cm.-Lengthening.cm.-Lengthening.

• External fixater period: 6 External fixater period: 6 monthsmonths

• Lengthening index:0.77Lengthening index:0.77

1cm discrepancy after 11cm discrepancy after 1stst surgerysurgery

22ndnd Stage Op: Plan Stage Op: PlanValgus Osteotomy+LengtheningValgus Osteotomy+Lengthening

• 2cm shortening in 2 y2cm shortening in 2 years 8 months follow ears 8 months follow up.(2 years 2 months up.(2 years 2 months after external fixater rafter external fixater removal)emoval)

• Still Trendelenburg limStill Trendelenburg limping gaitping gait

• Age: 13 years 6 montAge: 13 years 6 monthshs

22ndnd Stage Op: Stage Op:Valgus Osteotomy+LengtheningValgus Osteotomy+Lengthening

22ndnd Stage Op: Stage Op:Valgus Osteotomy+LengtheningValgus Osteotomy+Lengthening

• Immediate Post Immediate Post Op.Op.

• LLD:0.5 CMLLD:0.5 CM

• LENGTH LENGTH INCREASE BY INCREASE BY VALGUS VALGUS OSTEOTOMY OSTEOTOMY ALONEALONE

22ndnd Stage Op: Stage Op:Valgus Osteotomy+ Additional 2 cm Valgus Osteotomy+ Additional 2 cm lengthening lengthening

• Because further Because further shortening was shortening was anticipated as anticipated as observed in the observed in the follow up period.follow up period.

ResultResult

• InitialInitial• 1 year 5 months after remov1 year 5 months after remov

al of external fixateral of external fixater

1 year 5 months after external fixat1 year 5 months after external fixater removal,er removal,4 years 5 months after 1 st surgery4 years 5 months after 1 st surgery • 1.1 cm 1.1 cm

overlengthening(overlengthening(Jan,05)Jan,05)

• 0.7 cm 0.7 cm overlengthening(overlengthening(Sep,05)-very Sep,05)-very recent follow uprecent follow up

• Present age:15 Present age:15 years 3 monthsyears 3 months

• No limpingNo limping• Normal ROM of knee Normal ROM of knee

and hip,Rtand hip,Rt

Recent Follow UpRecent Follow Up

Discussion:Why 2 staged surgeries Discussion:Why 2 staged surgeries instead of single surgery?instead of single surgery?

• Possibility of One Stage Operation with external fPossibility of One Stage Operation with external fixation-More desirable if it is safe.ixation-More desirable if it is safe.

• But Risk of knee stiffness after valgus osteotomy But Risk of knee stiffness after valgus osteotomy and femoral lengthening because of abrupt soft tiand femoral lengthening because of abrupt soft tissue tensioning.ssue tensioning.

• Difficulties of predicting progress of degree of coDifficulties of predicting progress of degree of coxa vara deformity and further leg length discrepanxa vara deformity and further leg length discrepancycy

Plan : 2 staged surgeries for safety Plan : 2 staged surgeries for safety and predictability -and predictability -When to correct varus deformity?When to correct varus deformity?

• Varus deformity was intentionally not correVarus deformity was intentionally not corrected in 1cted in 1stst femoral after the lengthening. femoral after the lengthening.

• Varus hip protects the hip joint from the risVarus hip protects the hip joint from the risks of subluxation and dislocation during leks of subluxation and dislocation during lengtheningngthening..

Strategy of TreatmentStrategy of Treatment

• 1.Achieve full length by femoral lengthenin1.Achieve full length by femoral lengtheningg

• 2.Get soft tissue loosened up and the kne2.Get soft tissue loosened up and the knee motion returned + observe growthe motion returned + observe growth

• 3.Proximal Valgus Osteotomy with Ilizarov 3.Proximal Valgus Osteotomy with Ilizarov Apparatus and Lenghtening with limb realigApparatus and Lenghtening with limb realignmentnment..

ConclusionConclusion

• 2 Staged Proximal Valgus Osteotomy with 2 Staged Proximal Valgus Osteotomy with Femoral Lengthening by using Ilizarov ExterFemoral Lengthening by using Ilizarov External Fixater is a safe, versatile method of trnal Fixater is a safe, versatile method of treatment of Coxa Vara with femoral shorteneatment of Coxa Vara with femoral shortening.ing.

Thank you very much!Thank you very much!감사합니다감사합니다

김용욱김용욱Kim Yong Uck MDKim Yong Uck MD