PMC6370161_01
Pre-operative clinical view of left affected leg. The medial soft tissue of left lower leg was extremely contracted.
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F1
The movement range of ankle was 90  extension and 15 plantar flexion (Fig. 1; Video 1).
(A, B) Pre-operative X-Ray film of the affected leg.
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F2
A radiograph (Fig. 2A and B) showed the pelvis tilted to the left severely.
The first operation to release the medial soft tissue of left lower leg.
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F3
Therefore, we used the combined external fixator to distract the contractures of medial soft tissue gradually (Fig. 3).
The second operation of fusion the superior tibiofibular joint and fibular osteotomy.
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F4
One month later, the dislocated fibular head was pulled down and fused with the proximal tibia by 2 screws; the fibular osteotomy was also performed to correct the hypertrophied and curved fibula (Fig. 4).
Clinical view with external fixator during the lengthening.
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F5
The patient accepted our suggestion, and the femur was distracted 2-month postoperative of fibular osteotomy in the second stage (Fig. 5).
Radiograph showing the bone regenerate in the (A) femur and (B) fibula.
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F6
After 6 months of the femur lengthening, the fibula was prolonged and the equinovarus deformity of foot was corrected at the same time (Fig. 6A and B).
(A, B) Post-operative clinical view of 5 years follow-up.
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F7
But the left lower limb was still 2 cm shorter than the contralateral limb (Fig. 7A and B). The left lower limb was still 2 cm shorter than the contralateral limb (Fig. 7A and B).
Post-operative Radiograph showing the MAD of affected lower limb. MAD = mechanical axis deviation.
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F8
(A-D) The active ROM of the affected knee and ankle in the 5 years post-operative.
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F9
The knee function was extension 0  and flexion 40 . The active ROM of ankle was normal (Fig. 9A-D; Video 2).