Congenital Abnormalities of the Femur and Related Lower Extremity Malformations

Pappas, Arthur M.

doi:10.1097/01241398-198302000-00009

Cited by 125 publications

(60 citation statements)

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“…Demographic data and factors that might influence recurrence were analysed. All CFD cases were classified according to Pappas et al [2], and Achterman and Kalamchi classification was used for FH cases [4]. We further classified the knee and ankle joints with respect to presence and severity (mild, moderate, severe) of a so-called ball-and-socket joint.…”

Section: Methodsmentioning

confidence: 99%

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Recurrence of axial malalignment after surgical correction in congenital femoral deficiency and fibular hemimelia

Radler

Antonietti

Rudolf

et al. 2011

International Orthopaedics (SICOT)

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Purpose Recurrent genu valgum deformity complicates treatment of congenital femoral deficiencies (CFD) and fibular hemimelia (FH). We analysed factors influencing recurrence. Methods Patients who underwent limb lengthening or deformity correction for CFD and/or FH were reviewed. Radiographs after surgery and after a minimum of a further six months were analysed. Change in parameters of mechanical axis deviation per month (Δ MAD/month) and of angle per month were calculated. These parameters were tested against cofactors patient age, baseline MAD, type of CFD and FH, severity of ball-and-socket joints, ankle-joint stiffness, absence of cruciate ligaments and resection of the fibular anlage. Results Recurrent valgus deformity was found in 23 of the 42 limbs included with a mean change of MAD of 23.4 mm (5-60 mm). There was no significant difference between patients with Δ MAD/month <0.5 mm versus >1 mm regarding MAD in the first radiograph and patient age. CFD cases Pappas types VII and VIII showed a Δ MAD/month of 1.6 mm, whereas milder cases of Pappas IX showed a Δ MAD/month of 0.8. Mild FH (type Ia) showed a mean Δ MAD/month of 0.39 mm, whereas mean Δ MAD/month for FH type Ib/II was 0.72 mm. In FH type II cases, mean Δ MAD/month was 0.79 mm after resection of the fibular anlage compared with 1.98 mm in those without resection.Conclusions Recurrence in FH and CFD was not dependent on patient age but partly on FH and CFD type. Limbs with more severe ball-and-socket knee joints showed more recurrence. Overcorrection depending deformity type should be performed.

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Section: Methodsmentioning

confidence: 99%

“…CFD shows variable involvement of the femur from mild shortening to severe dysplasia [2,3]. FH presents with hypoplasia or aplasia of the fibula, with shortening and malalignment of the tibia, deformities at the knee and ankle joint and ray deficiencies [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Recurrence of axial malalignment after surgical correction in congenital femoral deficiency and fibular hemimelia

Radler

Antonietti

Rudolf

et al. 2011

International Orthopaedics (SICOT)

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“…Congenital femoral deficiency and fibular hemimelia are rare and complex congenital disorders of the lower limb, with an incidence of approximately one in 50,000 live births for congenital femoral deficiency [12,19,30] and between 7.4 to 20 per million live births [6,11,33] for fibular hemimelia. Congenital femoral deficiency and fibular hemimelia are found to be associated in the same limb in about 68% of cases [32].…”

Section: Introductionmentioning

confidence: 99%

Internal Lengthening Device for Congenital Femoral Deficiency and Fibular Hemimelia

Shabtai

Specht

Standard

et al. 2014

Clin Orthop Relat Res

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Background Patients with congenital limb shortening can present with joint instability, soft tissue contractures, and significant leg length discrepancy. Classically, lengthening is done with external fixation, which can result in scarring, pin site infection, loss of motion, and pain. We therefore developed an alternative to this approach, a new, controllable, internal lengthening device for patients with congenital limb shortening.

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“…Birch et al [5] proposed a new classification system for congenital fibular deficiency that was based on the functionality of the foot and leg length inequality. In a similar fashion, Pappas [19] proposed a nine-category classification system to cover the spectrum of femoral deficiency that later was modified by Paley [17]. The only rating system that has been developed evaluates femoral length discrepancies, but it has yet to be validated [18].…”

Section: Introductionmentioning

confidence: 99%

Limb Lengthening and Reconstruction Society AIM Index Reliably Assesses Lower Limb Deformity

McCarthy

Iobst

Rozbruch

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Although several systems exist for classifying specific limb deformities, there currently are no validated rating scales for evaluating the complexity of general lower limb deformities. Accurate assessment of the complexity of a limb deformity is essential for successful treatment. A committee of the Limb Lengthening and Reconstruction Society (LLRS) therefore developed the LLRS AIM Index to quantify the severity of a broad range of lower extremity deformities in seven domains.Questions/Purposes We addressed two questions: (1) Does the LLRS AIM Index show construct validity by correlating with rankings of case complexity? (2) Does the LLRS AIM Index show sufficient interrater and intrarater reliabilities? Methods We had eight surgeons evaluate 10 fictionalized patients with various lower limb deformities. First, they ranked the cases from simplest to most complex, and then they rated the cases using the LLRS AIM Index. Two or more weeks later, they rated the cases again. We assessed reliability using the Kendall's W test. Results Raters were consistent in their rankings of case complexity (W = 0.33). Patient rankings also correlated with both sets of LLRS AIM ratings (r 2 = 0.25; r 2 = 0.23). The LLRS AIM Index showed interrater reliability with an intraclass correlation (ICC) of 0.97 for Trial 1 and 0.98 for Trial 2 and intrarater reliability with an ICC of 0.94. The LLRS AIM Index ratings also were highly consistent between the attending surgeons and surgeons-in-training (ICC = 0.91). Conclusions Our preliminarily observations suggest that the LLRS AIM Index reliably classifies the complexity of lower limb deformities in and between observers.

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Congenital Abnormalities of the Femur and Related Lower Extremity Malformations

Cited by 125 publications

References 0 publications

Recurrence of axial malalignment after surgical correction in congenital femoral deficiency and fibular hemimelia

Recurrence of axial malalignment after surgical correction in congenital femoral deficiency and fibular hemimelia

Internal Lengthening Device for Congenital Femoral Deficiency and Fibular Hemimelia

Limb Lengthening and Reconstruction Society AIM Index Reliably Assesses Lower Limb Deformity

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