femoral hypoplasia is characterized by a lack of development on a femur which results in unequal leg length. This inequality may be more or less and go to 5 cm DE1 This percentage will remain constant throughout the child's growth and inequality can reach a length of about 5 to 12 cm in form Discrete and 20 to 25 cm for the more severe form. Other malformations may be associated with this inequality (deformity of the knee, hip dislocation).
Despite the importance of the gap between the lower limbs, the child learns to walk normally. The acquisition of the walk is at the usual age but generally compensates unequal length by walking on tiptoe (in "horse") and flexing the knee of the unaffected side.
As for measurement of growth, this compensation becomes insufficient and it is forced to avoid limp important to correct this difference in length by a femoral lengthening. The intervention, which usually focuses on the femur but may also involve the tibia, is feasible only if the femoral head and neck were normal.
The technique used is that of a gradual lengthening using a suitable apparatus (Ilizarov, Orthofix) affects only the inequalities below 15 cm. There is a newer method (Albizzia nail) that extends the member without element visible outside using an internal fixator. A metal rod is placed in the bone and the nail is gradually extended by the physician. But this technique is rarely used at the moment because we do not yet control the complications can be numerous.
The elongation of a member by Ilizarov has four stages. The first is to fracture the bone structure and set up the apparatus to maintain face-to-face and to eliminate gradually the two sides and separated.
The second step, elongation, is to move away from each other the two parts of the bone split, at about three quarters of a millimeter per day. This stage lasts two to four months depending on the importance of longer necessary. During this period, the skin, muscles and nerves are also involved stretching and undergo accelerated growth and cause pain, bruising and inflammation.
A member who has reached the required length, the elongation is stopped. The third stage, consolidation, which began during elongation, must be continued so that the bone newly formed solidifies and is strong enough to perform its function. This step is long double average time of elongation, that is to say between four and eight months.
When the bone is completely reformed within the space created and is on the radiological, homogeneous throughout its length, we can then proceed to the phased release of the device supported. This is the fourth step. Under general anesthesia, the surgeon makes finally the removal of the pins.
In total, it took a year to "rebuild the member", a permanent antibiotic coverage, hours of rehabilitation and care of pins.
The treatment is not completed, the rehabilitation will be extended, wearing a splint few hours a day, advised, resolving the issue of displacement of the axis of the knee, if undertaken must (by stapling internal wear another year ...) and finally one or more extensions can still be considered, if necessary, depending on the evolution of child growth during adolescence.
It will be understood, it is an adventure that is! But ultimately, we start upright on his legs and in life ...
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