Case 15: Periarticular Femur Deformity and LLD: A Modern Approach

Abstract

Periarticular deformity of the distal femur has been treated successfully with external fixation. Often a ring fixator is required to keep the osteotomy distal enough for accurate realignment. Although with the use of a fixator, one is able to achieve correction of the deformity and length, it comes with great discomfort, scarring, and impingement to knee motion. The LAP (lengthening and then plating) technique was designed to reduce the time in the frame by early conversion to a plate. This technique was complicated by difficulty controlling the distal femoral fragment, infection, and plate failure. With the introduction of a reliable internal lengthening nail, the problem of periarticular deformity and leg length discrepancy (LLD) can be reassessed. In the following case, a distal femoral plate is used to achieve an acute correction of a procurvatum deformity, and an internal lengthening nail is used proximally for limb length equalization providing an all-internal alternative to a complex problem.