Rami Jahmani1, Giovanni Lovisetti2, Mohammed Alorjani3, Khaldoon Bashaireh4. 1. Department of Special Surgery/Orthopaedic Division, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan. dr.Jahmany@yahoo.com. 2. Orthopaedic and Traumatology Unit, Menaggio Hospital, Menaggio, Italy. 3. Department of Pathology-Orthopaedic Pathology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan. 4. Department of Special Surgery/Orthopaedic Division, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan.
Abstract
INTRODUCTION: Closed femoral-shortening osteotomy over an intramedullary nail for the treatment of leg length discrepancy (LLD) is a demanding surgical technique, classically requiring specialized instrumentation (intramedullary saw and chisel). Herein, we describe our experience with shortening osteotomy over a nail, using a percutaneous multiple drill-hole osteotomy technique to perform the bone section with the osteotomized bone smashed and let on-site. METHOD: We operated on six patients with LLD due to: hemihypertrophy syndrome (three patients), congenital short femur, hemiplegic cerebral palsy, and growth plate injury. Mean femoral shortening was 4.2 cm. Osteotomy was performed via a multiple drill-hole technique, and femurs were stabilized using an intramedullary nail. Post-operative clinical and radiological data were recorded. Residual LLD was assessed through long-standing teleroentgenography. RESULTS: Shortening was achieved, with a final LLD of < 1 cm in all patients. All patients were satisfied and considered the lengths of the lower limbs to be equal. Our technique did not require special surgical skill or specialized instrumentation. Moreover, we did not record intraoperative and post-operative complications. DISCUSSION: Percutaneous femoral-shortening osteotomy over a nail using the on-site smashing osteotomy technique was effective and safe in treating LLD in this initial case series.
INTRODUCTION: Closed femoral-shortening osteotomy over an intramedullary nail for the treatment of leg length discrepancy (LLD) is a demanding surgical technique, classically requiring specialized instrumentation (intramedullary saw and chisel). Herein, we describe our experience with shortening osteotomy over a nail, using a percutaneous multiple drill-hole osteotomy technique to perform the bone section with the osteotomized bone smashed and let on-site. METHOD: We operated on six patients with LLD due to: hemihypertrophy syndrome (three patients), congenital short femur, hemiplegic cerebral palsy, and growth plate injury. Mean femoral shortening was 4.2 cm. Osteotomy was performed via a multiple drill-hole technique, and femurs were stabilized using an intramedullary nail. Post-operative clinical and radiological data were recorded. Residual LLD was assessed through long-standing teleroentgenography. RESULTS: Shortening was achieved, with a final LLD of < 1 cm in all patients. All patients were satisfied and considered the lengths of the lower limbs to be equal. Our technique did not require special surgical skill or specialized instrumentation. Moreover, we did not record intraoperative and post-operative complications. DISCUSSION: Percutaneous femoral-shortening osteotomy over a nail using the on-site smashing osteotomy technique was effective and safe in treating LLD in this initial case series.