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CASE REPORT
Leg Length Discrepancy in 14F
https://upload.orthobullets.com/cases/102707/a.jpg https://upload.orthobullets.com/cases/102707/b.jpg
A
Sanjeev Sabharwal MD
UCSF Benioff Children’s Hospital
Institute for Global Orthopaedics and Traumatology
Institute for Global Orthopaedics and Traumatology
Post-Traumatic Limb Deformities in Children and Young Adults: A Global Perspective 2025
Post-Traumatic Limb Deformities in Children and Young Adults: A Global Perspective 2025
VIEW EXPERT OPINIONS
HPI
In May 2019, a 14-year-old postmenarchal female presented with a right-sided limp, leg length discrepancy, and a fixed flexion deformity of the right ...knee. Radiographic and clinical images from this presentation are shown in Figures G, H, I, J, and K, and show she has 5. 9 cm of shortening, 43 degrees of procurvatum (apex anterior), and 5 degrees of valgus deformity of the right femur. Her history is notable for a traumatic injury in November 2015, approximately 3.5 years prior, at the age of 10. While playing, another child fell on her right knee, resulting in an isolated Salter-Harris type II fracture of the distal femur. Initial injury radiographs are provided in Figures A and B. The fracture was managed with closed reduction and percutaneous pinning (CRPP). Immediate postoperative radiographs are shown in Figures C and D. The fixation hardware was removed without complications approximately six weeks postoperatively. The patient was subsequently lost to follow-up and re-presented in August 2017 with progressive angular deformity of the right knee. Radiographs at that time demonstrated premature physeal arrest of the distal femur with associated flexion deformity. She was treated with anterior hemiepiphysiodesis of the distal femoral physis. Postoperative radiographs following this intervention are shown in Figures E and F.
2986   votes
7
(P: 214634) Now that the patient presents at age 14 with a procurvatum deformity and LLD of 5.9 cm (Figure G, H, I, J K), if you choose to correct deformity + lengthen short side, would you do it in a single procedure or staged procedure?
I would not choose to correct deformity + lengthen short side
1%
3/229
Single procedure
44%
102/229
Staged - Correct deformity 1st, then length short side at later date
47%
108/229
Staged - 1st lengthen short side, then correct deformity at later date
4%
11/229
Outside my area of expertise - best if I don't vote
2%
5/229
5   Surgeons
1
Timothy Mologne, MD Orthopedic & Sports Institute of the Fox Valley
TOP 5 %
Patient Care
United States of America
Last Month
United States of America
2
Krishan Kumar, MD delhi, IN
TOP 5 %
Patient Care
India
Last Week
India
3
Harry Steinman, MD Veracity-Benefits
TOP 5 %
Patient Care
United States of America
Last Year
United States of America
4
Oyoo Were, MD KNH, Nairobi, KE
TOP 5 %
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Kenya
Last Week
Kenya
5
Alejandro Fuentes Salazar, MD Caja Costarricense de Seguro Social (CCSS)
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Costa Rica
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Costa Rica
61   Countries
Leaflet
1
United States of America
54 surgeons
2
Spain
16 surgeons
3
Greece
13 surgeons
4
Israel
9 surgeons
5
United Kingdom of Great Britain and Northern Ireland
7 surgeons
53   Expert Comments
Juan Varela MD
TOP 5 %
Patient Care
Spain
Last Year
Well,it’s a extreme discrepancy paired with deformity Probably I’d get length 1st over a nail and secondarily angular correction
Stephen McHale
TOP 5 %
Patient Care
United Kingdom of Great Britain and Northern Ireland
Last Year
I’m curious as a non limb recon surgeon: once you’ve chosen to use a frame to address the distal femoral deformity, why not continue to lengthen through that osteotomy with the frame? Is this to shorten the period in a frame for the patient or are there other technical issues?
Jan Szatkowski MD
TOP 5 %
Patient Care
United States of America
Last Week
Wow—great result correcting the deformity and achieving limb lengthening. What’s your go-to method for femoral lengthening?
Anas Malkawi MD
TOP 5 %
Patient Care
Germany
Last Week
Jan Szatkowski, MD, MBA perfectly done. Lengthening of the femur in this case is best achieved with antegrade nail and diaphyseal osteotomy, distraction phase 1 mm a day. Ilisarov is also an option
David Bennett MD
I’d start with a hand bone age and make most calcs based on that. But lenthening isn’t a bad idea here at all
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Osteoblastoma
PMID: 10658718 AJR Am J Roentgenol. 2000 Feb;174(2):417-24.
E
post

Primary tumors of the sacrum: diagnostic imaging.

J Llauger
J Palmer
S Amores
S Bagué
A Camins
Primary tumors of the sacrum: diagnostic imaging.
Pubmed
Journal



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