Weinstein Lovell and Winters Pediatric Orthopaedics 7e

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CHAPTER 30  |  The Child with a Limb Deficiency

B

A

C

D E FIGURE 30-26. A : AP radiograph of the pelvis and limbs of a newborn girl with Aitken class B PFFD. Note the short femoral segment and the well-developed acetabulum, although the femoral head is not visible. B : By 5 years of age, the femoral head is ossified and the cartilaginous connection between the femoral head and the subtrochanteric region of the femur has undergone considerable ossification. However, a pseudarthrosis persists and a significant varus deformity has developed. C : The femur after correction of the varus with a spike type of osteotomy. D : The result 1 year later. Now faced with a pro- jected discrepancy of 20 cm, the parents elect a Van Nes rotationplasty. This was done with part of the rotation through the knee arthrodesis, and the remainder through the tibia. E : The radiographic result. The patient had one additional derotation performed through the midtibia at the age of 10 years.