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Femoral Lengthening in Children with Congenital Femoral Deficiency: A Systematic Review
Ahmed O Sabry1, Sherif Galal1,2, Rahma Menshawey3
1Department of Orthopaedic Surgery, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt.
Insights
This review examines limb lengthening techniques for congenital femoral deficiency (CFD), focusing on efficacy and complications. Individualized treatment and further research are crucial for improving outcomes in patients with proximal focal femoral deficiency (PFFD).
Area of Science:
- Pediatric Orthopaedics
- Limb Reconstruction Surgery
Background:
- Congenital femoral deficiency (CFD) encompasses a range of anomalies affecting femur development.
- Treatment of CFD, particularly proximal focal femoral deficiency (PFFD), poses significant challenges in pediatric orthopaedics.
Purpose of the Study:
- To review current concepts in femoral limb lengthening for CFD.
- To evaluate the efficacy, complications, and long-term outcomes of various surgical techniques for PFFD.
Main Methods:
- Comprehensive literature search of clinical studies on limb lengthening for PFFD.
- Analysis of surgical techniques including Wagner, Ilizarov, and distraction osteogenesis.
- Assessment of risk factors for complications and potential avoidance strategies.
Main Results:
- Evolution of limb lengthening procedures from traditional to advanced distraction osteogenesis.
- Evaluation of the role of different techniques in meeting functional needs.
- Identification of risk factors associated with specific lengthening methods.
Conclusions:
- Individualized treatment plans considering deficiency severity are essential for PFFD.
- A multidisciplinary approach and meticulous preoperative planning are vital for optimal outcomes.
- Ongoing research is needed to refine and compare surgical techniques for improved quality of life.
Background:
Congenital femoral deficiency (CFD) presents a significant challenge in pediatric orthopaedics, characterized by a spectrum of congenital anomalies ranging from mild femoral shortening to complete absence of the proximal femur and hip joint. This review aims at reviewing the latest concepts of femoral limb lengthening modalities in treating CFD, to explore the efficacy, complications, and long-term outcomes of various surgical techniques.
Methods:
A comprehensive search of the literature was performed for clinical studies involving lengthening in patients with proximal focal femoral deficiency (PFFD) in several databases.
Results:
We analyze the evolution of limb lengthening procedures, from the Wagner and Ilizarov methods to the latest advancements in distraction osteogenesis, and assess their role in addressing the functional needs of patients. We also analyze the possible risk factors for the occurrence of complications with each method and alternatives to avoid them.
Conclusion:
The review highlights the importance of individualized treatment plans, considering factors such as the degree of femoral deficiency and the potential for achieving a functional limb length; however, it requires a multidisciplinary approach and careful preoperative planning to optimize patient outcomes. The review underlines the need for ongoing research to refine surgical techniques and to compare them and improve the quality of life for individuals with PFFD.
Level Of Evidence:
Level III. See Instructions for Authors for a complete description of levels of evidence.
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