Antegrade Intramedullary Femoral Lengthening and Distal Temporary Hemiepiphysiodesis for Combined Correction of Leg Length Discrepancy and Coronal Angular Deformity in Skeletally Immature Patients
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 gain...
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| Format: | Article |
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MDPI AG
2023-04-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/8/3022 |
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| author | Andrea Laufer Adrien Frommer Georg Gosheger Gregor Toporowski Jan Duedal Rölfing Carina Antfang Robert Roedl Bjoern Vogt |
| author_facet | Andrea Laufer Adrien Frommer Georg Gosheger Gregor Toporowski Jan Duedal Rölfing Carina Antfang Robert Roedl Bjoern Vogt |
| author_sort | Andrea Laufer |
| collection | DOAJ |
| description | 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 (<i>n</i> = 11), simultaneously (<i>n</i> = 10) or subsequently (<i>n</i> = 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. |
| first_indexed | 2024-03-11T04:52:36Z |
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| id | doaj.art-05e743ce0460402181e5afb8e0ba9d0c |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T04:52:36Z |
| publishDate | 2023-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-05e743ce0460402181e5afb8e0ba9d0c2023-11-17T19:51:48ZengMDPI AGJournal of Clinical Medicine2077-03832023-04-01128302210.3390/jcm12083022Antegrade Intramedullary Femoral Lengthening and Distal Temporary Hemiepiphysiodesis for Combined Correction of Leg Length Discrepancy and Coronal Angular Deformity in Skeletally Immature PatientsAndrea Laufer0Adrien Frommer1Georg Gosheger2Gregor Toporowski3Jan Duedal Rölfing4Carina Antfang5Robert Roedl6Bjoern Vogt7Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, 48149 Muenster, GermanyPediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, 48149 Muenster, GermanyGeneral Orthopedics and Tumor Orthopedics, Muenster University Hospital, 48149 Muenster, GermanyPediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, 48149 Muenster, GermanyPediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, 48149 Muenster, GermanyPediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, 48149 Muenster, GermanyPediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, 48149 Muenster, GermanyPediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, 48149 Muenster, GermanyLeg 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 (<i>n</i> = 11), simultaneously (<i>n</i> = 10) or subsequently (<i>n</i> = 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.https://www.mdpi.com/2077-0383/12/8/3022leg length discrepancyangular deformitydistraction osteogenesistemporary hemiepiphysiodesisPRECICE<sup>®</sup> lengthening nailFlexTack<sup>TM</sup> guided growth staple |
| spellingShingle | Andrea Laufer Adrien Frommer Georg Gosheger Gregor Toporowski Jan Duedal Rölfing Carina Antfang Robert Roedl Bjoern Vogt Antegrade Intramedullary Femoral Lengthening and Distal Temporary Hemiepiphysiodesis for Combined Correction of Leg Length Discrepancy and Coronal Angular Deformity in Skeletally Immature Patients Journal of Clinical Medicine leg length discrepancy angular deformity distraction osteogenesis temporary hemiepiphysiodesis PRECICE<sup>®</sup> lengthening nail FlexTack<sup>TM</sup> guided growth staple |
| title | Antegrade Intramedullary Femoral Lengthening and Distal Temporary Hemiepiphysiodesis for Combined Correction of Leg Length Discrepancy and Coronal Angular Deformity in Skeletally Immature Patients |
| title_full | Antegrade Intramedullary Femoral Lengthening and Distal Temporary Hemiepiphysiodesis for Combined Correction of Leg Length Discrepancy and Coronal Angular Deformity in Skeletally Immature Patients |
| title_fullStr | Antegrade Intramedullary Femoral Lengthening and Distal Temporary Hemiepiphysiodesis for Combined Correction of Leg Length Discrepancy and Coronal Angular Deformity in Skeletally Immature Patients |
| title_full_unstemmed | Antegrade Intramedullary Femoral Lengthening and Distal Temporary Hemiepiphysiodesis for Combined Correction of Leg Length Discrepancy and Coronal Angular Deformity in Skeletally Immature Patients |
| title_short | Antegrade Intramedullary Femoral Lengthening and Distal Temporary Hemiepiphysiodesis for Combined Correction of Leg Length Discrepancy and Coronal Angular Deformity in Skeletally Immature Patients |
| title_sort | antegrade intramedullary femoral lengthening and distal temporary hemiepiphysiodesis for combined correction of leg length discrepancy and coronal angular deformity in skeletally immature patients |
| topic | leg length discrepancy angular deformity distraction osteogenesis temporary hemiepiphysiodesis PRECICE<sup>®</sup> lengthening nail FlexTack<sup>TM</sup> guided growth staple |
| url | https://www.mdpi.com/2077-0383/12/8/3022 |
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