Congenitally Short Femur

Incidence

 

20 - 30 % LLD

 

Features

 

Intact femur radiographically +

- foot at contralateral mid-tibial level

- cruciate ligament deficiency

- coxa vara

- hypoplastic lateral femoral condyle with resulting valgus knee

- sclerosed lateral cortex

 

Amount of femoral shortening is variable patient to patient

 

Shapiro Type 1 growth disturbance

- i.e. LLD increases with time

 

Examination

 

LLD

Genu valgum

Fat thigh

High riding patella

 

Foot held externally rotated

 

X-ray

 

Hypoplastic femur

Coxa vara

Lateral sclerosis

 

2 groups

 

Simple femur hypoplasia

 

Femoral hypoplasia with coxa vara

 

Management

 

Align early then lengthen in primary school years

 

1. Realignment may involve

 

Coxa vara

- proximal femoral valgising osteotomy

 

Valgus knee

- Supracondylar osteotomy / guided growth 8 plates

 

2. Lengthen tibia and femur

 

Caution for dislocated knee

- ACL deficient

 

3. Contralateral epiphysiodesis