1. Treatment of Congenital Femoral Shortening with Coxa Vara 김용욱 김용욱 정형외과 Yong U Kim Dr.Kim’s Orthopaedic Clinic

2. CC: Limping gait and Leg length discrepancy 10years and 10 months old,male

3. CC: Limping Gait and Leg Length Discrepancy 10years and 10 months old,male

4. Coxa Vara + 5.7 cm. Shortening.

5. Tasks Elimination of Trendelenburg type limping gait Elimination of Trendelenburg type limping gait Equalize leg length discrepancy Equalize leg length discrepancy Prevent possible further progress of deformity Prevent possible further progress of deformity

6. Solving the Problems of Coxa Vara and Shortening of Femur

7. Plan 2 Staged Surgeries 2 Staged Surgeries 1 st : Femoral Lengthening 1 st : Femoral Lengthening 2 nd :Correction of Coxa Vara + Lengthening if needed 2 nd :Correction of Coxa Vara + Lengthening if needed

8. 1 st Stage Op:Femoral Lengthening Lengthening with Ilizarov External Fixater Lengthening with Ilizarov External Fixater

9. Femoral Lengthening Midphase

10. 4.7 cm.-Lengthening. 4.7 cm.-Lengthening. External fixater period: 6 months External fixater period: 6 months Lengthening index:0.77 Lengthening index:0.77

11. 1cm discrepancy after 1 st surgery

12. 2 nd Stage Op: Plan Valgus Osteotomy+Lengthening 2cm shortening in 2 years 8 months follow up.(2 years 2 months after external fixater removal) 2cm shortening in 2 years 8 months follow up.(2 years 2 months after external fixater removal) Still Trendelenburg limping gait Still Trendelenburg limping gait Age: 13 years 6 months Age: 13 years 6 months

13. 2 nd Stage Op: Valgus Osteotomy+Lengthening

14. Immediate Post Op. Immediate Post Op. LLD:0.5 CM LLD:0.5 CM LENGTH INCREASE BY VALGUS OSTEOTOMY ALONE LENGTH INCREASE BY VALGUS OSTEOTOMY ALONE

15. 2 nd Stage Op: Valgus Osteotomy+ Additional 2 cm lengthening Because further shortening was anticipated as observed in the follow up period. Because further shortening was anticipated as observed in the follow up period.

17. Result Initial Initial 1 year 5 months after removal of external fixater 1 year 5 months after removal of external fixater

18. 1 year 5 months after external fixater removal, 4 years 5 months after 1 st surgery 1.1 cm overlengthening(Jan, 05) 1.1 cm overlengthening(Jan, 05) 0.7 cm overlengthening(Sep, 05)-very recent follow up 0.7 cm overlengthening(Sep, 05)-very recent follow up Present age:15 years 3 months Present age:15 years 3 months

20. No limping No limping Normal ROM of knee and hip,Rt Normal ROM of knee and hip,Rt

21. Recent Follow Up

22. Discussion:Why 2 staged surgeries instead of single surgery? Possibility of One Stage Operation with external fixation-More desirable if it is safe. Possibility of One Stage Operation with external fixation-More desirable if it is safe. But Risk of knee stiffness after valgus osteotomy and femoral lengthening because of abrupt soft tissue tensioning. But Risk of knee stiffness after valgus osteotomy and femoral lengthening because of abrupt soft tissue tensioning. Difficulties of predicting progress of degree of coxa vara deformity and further leg length discrepancy Difficulties of predicting progress of degree of coxa vara deformity and further leg length discrepancy

23. Plan : 2 staged surgeries for safety and predictability - When to correct varus deformity? Plan : 2 staged surgeries for safety and predictability - When to correct varus deformity? Varus deformity was intentionally not corrected in 1 st femoral after the lengthening. Varus deformity was intentionally not corrected in 1 st femoral after the lengthening. Varus hip protects the hip joint from the risks of subluxation and dislocation during lengthening. Varus hip protects the hip joint from the risks of subluxation and dislocation during lengthening.

24. Strategy of Treatment 1.Achieve full length by femoral lengthening 1.Achieve full length by femoral lengthening 2.Get soft tissue loosened up and the knee motion returned + observe growth 2.Get soft tissue loosened up and the knee motion returned + observe growth 3.Proximal Valgus Osteotomy with Ilizarov Apparatus and Lenghtening with limb realignment. 3.Proximal Valgus Osteotomy with Ilizarov Apparatus and Lenghtening with limb realignment.

25. Conclusion 2 Staged Proximal Valgus Osteotomy with Femoral Lengthening by using Ilizarov External Fixater is a safe, versatile method of treatment of Coxa Vara with femoral shortening. 2 Staged Proximal Valgus Osteotomy with Femoral Lengthening by using Ilizarov External Fixater is a safe, versatile method of treatment of Coxa Vara with femoral shortening.

26. Thank you very much! 감사합니다 김용욱 Kim Yong Uck MD