Repeated Surgeries and Clinical Assessment Using 3D Gait Analysis in Unilateral Congenital Short Femur: A Case Report

There are numerous etiologies relating to limb length discrepancy (LLD). Clinical manifestations of LLD may include gait abnormality and compensatory scoliosis. Congenital short femur (CSF) is a rare congenital skeletal abnormality with several manifestations, including coxa vara, abnormalities of the cruciate ligaments, hypoplasia of the lateral femoral condyle, fibular hemimelia, ball-in-socket ankle, and tarsal coalition.

A 4-month-old female was referred to a primary care hospital following findings of LLD and significant thigh circumference discrepancy. She was initially monitored with regular radiographic assessment. On achieving independent standing, she was prescribed an orthosis. At the age of 3 years, she was referred to a specialized pediatric orthopedic facility because her LLD exceeded 3 cm. At the age of 8 years, her LLD had increased to 5.6 cm, and she suffered from gait abnormality. We thereafter performed several surgeries, including external fixation, contralateral epiphysiodesis, intramedullary nail insertion, and partial fibular resection, accompanied by three-dimensional gait analysis (3DGA), over the period from age 8.0 to 14.3 years. At age 14.3 years, LLD had improved to within 1 cm on radiographic findings. On 3DGA, her gait profile score improved from 20.4° at 8.0 years to 7.9° at 14.6 years, corresponding to 7.8 times the minimal clinically important difference.

This is the first report of both pre- and post-operative 3DGA across several surgeries for a patient with CSF. Although CSF is a challenging disorder, amelioration of LLD and avoidance of long-term immobilization across the knee joint might lead to improved gait function. Physicians who manage children involved with severe LLD should assess improvement not only based on radiographic findings but also on activities of daily living, including gait function.