Abstract
Introduction: The aim of the study is to assess the complication rate in lengthening of the femur and to analyze the main factors inducing complications.
Materials & method: A retrospective study of 151 cases of lengthening with different methods (External Fixator of Judet 9, Callotasy with Orthofix :89, Ilizarov 9, External Fixator of Wagner 9, Lengthening Albizzia Nail 29) was investigated. The mean age was 13, 21 years (ET : 4,82, max : 38, min : 4). The aetiologies of femoral length discrepancy were congenital in 85 cases, post traumatic in 30, Post infectious in 22 and neurologic in 13 cases. One girl had Still’s Disease. The mean elongation was 55,17mm (ET : 17,3, Max ; 130, min : 20) except with the Ilizarov method with a mean lengthening of 91,8 mm. The mean percentage of elongation was 21 %
Classification of the Complications was in three grades :
-
- I : Benign complication without any unexpected surgery or anaesthesia
-
- II : Serious complication with unexpected surgery or anaesthesia
-
- III : Severe complication
The complications were recorded in four periods: surgery, elongation, consolidation and late complications
Results: There were 151 complications (78 Grade I, 59 grade III, 14 grade III). There were only three complications during first surgical procedure, 95 during elongation 49 during consolidation and 4 late complications. Analysis of the different pathologies shows that the rate of complications is the same for each etiology (around 100%) but the rate of complications of grade 2 and 3 shows a significant difference with a higher rate for neurological and congenital aetiologies. Benign complications are found in the post infection group. Analysis of the different methods used shows the same rate of complications in benign conditions except for the Albizzia Nail with a significant lower rate. Complications of grade 2 are seen in the ancient Judet method and in the Albizzia Nail due to the multiple general anaesthesia . Complications of grade 3 are seen in the Wagner method due to a high rate of congenital pathology and to a mean lengthening of 35 % of femoral initial length.
Articular complications do not show any significant difference between the different methods. The main complications are seen in neurological and post infectious diseases. The mean percentage of lengthening in these complications is not different of the mean percentage of the series.
Conclusion: Lengthening of the femur is still a difficult problem with a mean rate of complications of 100 % The type of method used is not the main determinant in the appearance of these complications. We want to emphazise the difficulties in performing lengthenings in neurological and congenital pathologies.
The abstracts were prepared by Editorial Secretary, Mr Robin W Paton. Correspondence should be addressed to BSCOS at the Royal College of Surgeons, 35– 43 Lincoln’s Inn Fields, London WC2A 3PN
