Abstract
Introduction and Aims: To review the existing classifications in characterising the pathologic morphology of congenital lower limb deficiencies (CLLLD) and their usefulness in planning limb reconstruction.
Method: Ninety-five patients undergoing limb reconstruction were classified using existing classifications. Predominantly femoral deficiencies were classified using Aitken, Amstutz, Hamanishi, Gillespie and Torode, Fixsen and Lloyd-Roberts, Kalamchi, and Pappas systems and fibular deficiencies were classified using Coventry and Johnston, Achterman and Kalamchi, and Birch systems.
Results: All patients with predominant deficiency of one segment (femoral or fibular) also had associated shortening of the other segment in the same limb. Acetabular dysplasia, knee instability due to cruciate insufficiency and lateral femoral condylar hypoplasia were found in both femoral and fibular deficiencies. None of the existing classification systems were able to represent the complete pathologic morphology in any given patient. Due consideration of alignment, joint stability and length discrepancy of affected limb as a whole at the planning stage of reconstruction could not be ascertained using these classification systems. Instead, it was useful to characterise the morphology of the involved limb using the following method:
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Acetabulum: Dysplastic/Non-dysplastic
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Ball (Head of femur): Present/Absent
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Cervix (Neck of femur): Pseudoarthrosis and neck-shaft angle
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Diaphysis of femur: Length/deformity
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Knee: Cruciates
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Fibula and Tibia: Length/deformity
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Ankle: Normal/Ball and socket/valgus
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Heel: Tarsal coalition/deformity
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Ray: Number of rays in the foot
Conclusion: Existing classifications do not represent the complete morphology of the entire involved lower limb in CLLLD and therefore a systematic method of characterising the morphology of the lower limb is more useful in planning limb reconstruction.
These abstracts were prepared by Editorial Secretary, George Sikorski. Correspondence should be addressed to Australian Orthopaedic Association, Ground Floor, The William Bland Centre, 229 Macquarie Street, Sydney, NSW 2000, Australia.
None of the authors is receiving any financial benefit or support from any source.
