Advice on proper timing and prioritization of procedures, from the National Library of Medicine by Ms. Drakou and her colleagues.
We present the case of a fifteen-year-old female with achondroplasia who requested femoral lengthening with intramedullary nails. The patient had already undergone double tibial lengthening at age eleven and presented with:
- Varus deformity of the right lower limb
- Lateral thrust of the right knee
- Valgus deformity of the left lower limb
We performed a deformity analysis based on mechanical axis measurements and proceeded with a gradual surgical plan.
Clinical and technical points:
- In adolescence with achondroplasia, correction of bony deformities must take into account the ongoing growth of the fibula.
- Lateral knee instability was corrected by gradual distalization of the fibular head using Ilizarov-type external fixation, with the amount of distalization determined clinically.
- Tibial lengthening and femoral valgus accentuate laxity of the lateral collateral ligament (LCL).
- In patients with ACH, tibial lengthening and, where necessary, distal femoral valgus correction should precede LCL tightening.
- Femoral lengthening should be performed last.
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