Muscle function after femoral shortening osteotomies at the subtrochanteric and mid-diaphyseal level

Abstract

Relative femoral shortening length at the subtrochanteric (ST) and mid-diaphyseal (MD) level was compared with isokinetic muscle strength more than 2 years postoperatively. For the ST level no upper limit for shortening length could be detected. For MD osteotomies the relative shortening length was negatively correlated to muscle strength. There was a significant difference at the MD level between those shortened more or less than 10%, indicating an upper limit of 10% of the femoral length for regaining normal muscle strength. For correction of leg length inequality and for shortening of unaccepted tallness, these results should be taken into account when choosing the level for osteotomy.

Recovery of function after closed femoral shortening

“…Other authors have suggested that the effect on the hamstrings tends to be less. 18 In contrast to the study by Holm et al, 10 we found that after two years the quadriceps and hamstrings had recovered to within 93% and 96% of their pre-operative values respectively, a change that was not statistically significant. There are a number of reasons that may explain this difference.…”

“…This concurs with other studies of muscle function after femoral shortening. 10,12,18 It is of interest that atrophy of the quadriceps was more pronounced than of the hamstrings and that recovery was slower, particularly as the rehabilitation protocols tend to place greater emphasis on strengthening the former. Muscle is known to waste more if it is splinted in a shortened position 19 which may explain this observation.…”

“…The site of osteotomy in our patients was more proximal, in the subtrochanteric region, compared with the midshaft osteotomy of Holm et al 10 A more proximal osteotomy may result in better preservation of the quadriceps strength as the greater part of the muscle bellies will be distal to and therefore not adherent to the callus of the osteotomy. 7,10,18 It has been reported that percentage shortening and strength are related, particularly when the former exceeds 10%. 10 In our series, one patient undergoing a simultaneous bilateral procedure, had shortening of 15% and 18%, the other patients had reductions ranging from 5% to 9%.…”

Leg Length Discrepancy Treatment with Subtrochanteric Shortening Osteotomy and Blade Plate Fixation

“…Me to da osteoto mii skra ca ją cej sko śnej sta bi li zo wa nej 3 śru ba mi ana li zo wa na przez Rusz kow skie go wią że się, w je go opi nii, ze zbyt dłu gim okre sem od cią ża nia koń czy ny (6 ty go dni gip su bio dro we go, czę ścio we ob cią ża nie po 12 ty go dniach, peł ne ob cią ża nie do pie ro po 19 tygo dniach) [6]. Nord slet ten i współ au to rzy w przypad ku oste oto mii ty pu "Z" sto so wa li peł ne ob cią żanie do pie ro po 4 mie sią cach [7]. Koł ban i Kró lew ski nie sto so wa li unie ru cho mie nia w gip sie, ale za kaz ob cią ża nia koń czy ny obej mo wał okres od 2 do 4 miesięcy (śred nia 3 mie sią ce) [8].…”

“…The method of oblique shortening osteotomy stabilised by 3 screws as analysed by Ruszkowski necessitates, in his opinion, a too long period of limb unloading (6 weeks in a hip plaster cast, with partial loading after 12 weeks and full loading only after 19 weeks) [6]. Nordsletten and others used full loading only after 4 months following a "Z" type osteotomy [7]. Kołban and Królewski did not use plaster immobilisation but weight-bearing was prohibited for 2-4 months (mean: 3 months) [8].…”