CHAPTER 30
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The Child with a Limb Deficiency
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A
B
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.
