Antegrade Intramedullary Femoral Lengthening and Distal Temporary Hemiepiphysiodesis for Combined Correction of Leg Length Discrepancy and Coronal Angular Deformity in Skeletally Immature Patients

Andrea Laufer*, Adrien Frommer, Georg Gosheger, Gregor Toporowski, Jan Duedal Rölfing, Carina Antfang, Robert Roedl, Bjoern Vogt

*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

6 Citations (Scopus)
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Abstract

Leg length discrepancies (LLD) are frequently associated with coronal malalignment. Temporary hemiepiphysiodesis (HED) is a well-established procedure for the correction of limb malalignment in skeletally immature patients. For treatment of LLD > 2 cm, lengthening with intramedullary devices gains increasing popularity. However, no studies have investigated the combined application of HED and intramedullary lengthening in skeletally immature patients. This retrospective single-center study evaluated the clinical and radiological outcomes of femoral lengthening with an antegrade intramedullary lengthening nail combined with temporary HED performed in 25 patients (14 females) between 2014 and 2019. Temporary HED through the implantation of flexible staples of the distal femur and/or proximal tibia was either performed prior (n = 11), simultaneously (n = 10) or subsequently (n = 4) to femoral lengthening. The mean follow-up period was 3.7 years (±1.4). The median initial LLD was 39.0 mm (35.0–45.0). Twenty-one patients (84%) presented valgus and four (16%) showed varus malalignment. Leg length equalization was achieved in 13 of the skeletally mature patients (62%). The median LLD of the eight patients with residual LLD > 10 mm at skeletal maturity was 15.5 mm (12.8–21.8). Limb realignment was observed in nine of seventeen skeletally mature patients (53%) in the valgus group, and in one of four patients (25%) in the varus group. Combining antegrade femoral lengthening and temporary HED is a viable option to correct LLD and coronal limb malalignment in skeletally immature patients; however, achieving limb length equalization and realignment may be difficult in cases of severe LLD and angular deformity, in particular.

Original languageEnglish
Article number3022
JournalJournal of Clinical Medicine
Volume12
Issue8
ISSN2077-0383
DOIs
Publication statusPublished - Apr 2023

Keywords

  • angular deformity
  • distraction osteogenesis
  • FlexTack guided growth staple
  • leg length discrepancy
  • PRECICE lengthening nail
  • temporary hemiepiphysiodesis

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