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

Abstract

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.

Lengthening With External Fixation Is Effective in Congenital Femoral Deficiency

“…Recently, Oostenbroek et al reported a complication rate of 69% per lengthened bone and showed that limb length discrepancy is the only predictor for complications after surgery [26]. The proportion of fractures in our study was 16.7% (five of 30) per lengthened segments compared with published rates of 8% to 50%, and the proportion of hip and knee contracture/stiffness was 30% (nine of 30) per lengthened segments compared with published rates of 10% to 85% [4,9,19,26,35,36,39]. Other postoperative obstacles and complications found in our series occurred within published ranges: modifications of the external fixator in the operating room (13.3%); Botox injections into the hamstrings and manipulations under anesthesia (10%); osteomyelitis (3%); loss of regenerate length (3%); quadricepsplasty (3%); and pin exchange in the operating room (3%).…”

Internal Lengthening Device for Congenital Femoral Deficiency and Fibular Hemimelia

“…One limitation of our study is the length of followup (mean, 14 months). This length does not permit us to see whether deformity recurs, a finding described in Radler et al [31]. It also does not allow us to identify late complications related to the hardware itself.…”

Common Patterns of Congenital Lower Extremity Shortening: Diagnosis, Classification, and Follow-up

“…For patients who undergo lengthening procedures, radiographic follow-up is important for the detection of late complications such as tibial axial deformities (valgus or varus deformities), progressive anterior tibial bowing, and progression of ankle and foot deformities (Fig 15) (33,41).…”