Femoral Lengthening Using a Periosteal Sleeve

REPORT ON TWENTY-SIX CASES

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Thirty-three consecutive femoral lengthening procedures on twenty-six patients are reviewed. In all cases the periosteal sleeve technique as described was used. Many of the patients with residua of anterior poliomyelitis had additional stabilizing operative procedures not analyzed in this review. Ten patients had epiphyseodesis either prior to or after lengthening procedures.

Care must be taken in selecting the method of lengthening as well as the type of patient for lengthening. Segmental lengthening by interposition of a graft should be limited to about three centimeters unless a simultaneous shortening of the opposite limb is performed. This type of lengthening procedure is more feasible for very short femora on which the Bost apparatus is difficult to apply. Slow countertraction by the Bost apparatus permits lengthening of five to six cetimeters. Steinmann pins should be at least 3/16 inches in diameter to prevent bending and cutting out through the bone. Careful positioning of the pins is essential. Weakened and distorted abnormal bone may not provide a sufficient purchase for the pins (Figs. 7-A and 7-B).

No complications were attributed to the transverse osteotomy. After surgery, incorporation of the lengthened limb in a hip spica cast may greatly reduce the complications accompanying this method of lengthening. If sciatic-nerve palsy occurs secondary to stretching, lengthening must be halted immediately. Complete return of sciatic function is then usually seen.

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