Acute Femoral Lengthening in Adults Using Step-Cut Osteotomy, Traction Table, and Proximal Femoral Locking Plate Fixation: Surgical Technique and Report of Three Cases

Abstract

Introduction: Leg-length discrepancy (LLD) can cause distinct gait and posture disorders that may lead to lifestyle-limiting disability and premature joint degeneration. The purpose of this study was to describe a novel surgical method for acute femoral lengthening in adults with symptomatic structural LLD using step-cut osteotomy, traction table, and proximal femoral locking plate fixation.

Materials and methods: We retrospectively evaluated three consecutive adult patients that underwent the procedure at our institution between 2011 and 2019, describing the surgical technique and presenting a report of three cases, including complications assessment.

Results: The average age was 47 years (range 38-58), average BMI was 28.1 kg/m² (range 26.8-29.9), average ASA score was 2 (range 1-3). The mean pre-operative shortening (2 congenital, 1 posttraumatic) was 21 mm (range 20-23). The average elongation achieved was 18 mm (range 15-20). The average surgery duration was 142 min (range 120-165) and the average estimated blood loss was 558 mL (range 375-900). Symptoms were relieved after the lengthening in all three cases. We observed no complications after the mean 68 months (range 22-125) of follow-up.

Conclusions: Successful correction of structural LLD is challenging, depends on patient selection, meticulous planning, surgical technique and experience. Therefore, it should be considered case-by-case. In the hands of an experienced surgeon, our method of acute femoral lengthening seems safe and suitable for carefully selected cases of structural LLD correction, where the final lengthening goal remains within the critical limits of one-stage leg lengthening and principles of traction table use.

Keywords: Acute lengthening; Femoral elongation; Femoral lengthening; Femoral osteotomy; LLD; Leg length inequality; Leg-length discrepancy; Locking plate; One-stage; Proximal femoral osteotomy.

Fig. 1

Congenital defect responsible for the LLD in cases #1 and #3 was bone shortening

Fig. 2

LLD in case #2 was a sequela of post-traumatic deformity. X-ray taken with a raise supporting the left leg

Fig. 3

Schematic 3D representation of the step-cut osteotomy (above) and the final position of the osteotomy after mobilization (below)

Fig. 4

Patient #1 with congenital shortening. Immediate postoperative X-ray (A), after 6 months of follow-up (B) and after 106 months of follow-up (C). The osteotomy gaps were not grafted

Fig. 5

Patient #2 with acquired shortening and residual posttraumatic ossifications. Immediate postoperative X-ray (A, B), after 2 months of follow-up (C, D) and after 26 months of follow-up (E, F). The osteotomy gaps were grafted with the autograft bone from the ipsilateral iliac crest

Fig. 6

Patient #3 with congenital shortening. Immediate postoperative X-ray (A–C) and after 12 months of follow-up (D–F). The osteotomy gaps were grafted with the allograft bone from the hospital’s tissue bank