Treatment of 18 cm lower limb length discrepancy using lengthening over nail technique in tibia and lengthening and plating in femur – A case report

INTRODUCTION AND IMPORTANCE: The management of extreme limb-length discrepancy remains a challenge for surgeons. Limb lengthening using an external fixator is a popular method for managing limb-length discrepancy; however, it had many complications. Other techniques using external fixators have been described, such as lengthening over a nail (LON) technique and lengthening and then plating (LATP), which decrease external fixator duration, equinus contracture, pin-site infection, bone alignment, and bone fracture. Only a few cases of management of extreme limb-length discrepancy due to hip dysplasia using LATP and LON techniques are reported in the literature. CASE PRESENTATION: We report a 24-year-old case of an 18 cm lower limb length discrepancy, who had tibial lengthening and Chiari pelvic osteotomy for treatment of congenital hip dislocation 12 years ago. The treatment for the patient was underwent the lengthening over nail technique in the tibia and lengthening and then plating in the femur. 9 months post-operative, the tibia and femur are union. The patient reported no pain and could walk and climb stairs without a crutch. CLINICAL DISCUSSION: Following pelvic osteotomy, leg lengthening is a good treatment for limb-length discrepancy due to hip dysplasia. The LON technique or LATN in the tibia and in the femur is an alternative choice for the treatment of extreme limb-length discrepancy. Lengthening and then plating could be widely employed in patients who are not suitable for the LON technique. Although the patient had gained the 18 cm lengthening, the range of motion of the left knee joint and left ankle joint was unrestricted, and without neurovascular complication. CONCLUSION: Following pelvic osteotomy, LON technique in the tibia and or LATP in the femur is considered an alternative choice for the treatment of extreme limb-length discrepancy due to hip dysplasia. LATP should be widely employed in patients who are not suitable for limb lengthening over a nail. LEVEL OF EVIDENCE: A case report.