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Staged correction of varus knee and lateral thrust in an achondroplastic (ACH) juvenile patient who underwent limb lengthening with IM nails: tips for proper timing and prioritisation of procedures
  1. Androniki Drakou1,
  2. Lukia Koutsogewrgopoulou2,
  3. Georgios Boutzios3 and
  4. Markos Psifis1
  1. 1Orthopaedic, Laiko General Hospital, Athens, Greece
  2. 2Internal Medicine, Laiko General Hospital, Athens, Greece
  3. 3Endocrinology, Laiko General Hospital, Athens, Greece
  1. Correspondence to Dr Androniki Drakou; ninadrakou{at}; Dr Lukia Koutsogewrgopoulou;{at}


We present the case of a fifteen-year-old achondroplastic (ACH) woman who requested to have her femurs lengthened by intramedullary nails. She had undergone bilateral tibial lengthening at the age of eleven and presented with a varus deformity of the right lower limb, lateral thrust of the right knee and valgus deformity of the left lower limb. We performed deformity analyses based on mechanical axis measurements, and we came with a staged surgical plan. In ACH adolescences, correction of bony deformity needs to encounter continuous fibula growth dynamics. Lateral knee thrust was corrected by gradual distal translation of the fibula head via an Ilizarov frame and the amount of translation we decided clinically. Tibial lengthening and valgus osteotomy of the distal femur accentuate lateral collateral ligament (LCL) complex laxity. In patients with ACH, tibial lengthening and valgus osteotomy of the distal femur—if needed—should precede LCL complex tightening, and femoral lengthening should follow.

  • paediatric surgery
  • orthopaedic and trauma surgery
  • congenital disorders
  • healthcare improvement and patient safety
  • genetics

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  • Contributors AD, GB and LK contributed substantially to the conception of the work as they are members of the Center of Rare Bone Diseases at Laikon Hospital, Athens, Greece. The center awaits nomination as Centre of Excellence for Rare Bone Diseases by the Greek Ministry of Health. AD performed the surgeries and the mechanical axis analyses and prepared the initial manuscript. They have all contributed to the acquisition of data and have critically revisited the work for important intellectual content. MP has worked on literature research and helped with the technical preparation of the manuscript and images. All authors have given final approval of the version to be published and agree to be accountable for all aspects of the work. AD is the corresponding author as well as the guarantor who accepts full responsibility for the finished work, had access to the data and controlled the decision to publish.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.