Single-Stage Double-Level Ilizarov Reconstruction for Distal Congenital Femoral Deficiency in Early Childhood: A Case Report.

BACKGROUND: Congenital femoral deficiency (CFD) with primary distal involvement (Paley Type 4) is the rarest phenotype in a spectrum that affects roughly 1 in 40,000-100,000 live births. Such children present early with pronounced limb length discrepancy (LLD), genu valgum, and patellofemoral maltracking.

CASE PRESENTATION: We describe a 4-year-old girl who exhibited an 8 cm right-sided LLD, severe distal femoral valgus, and hypoplasia of the lateral femoral condyle. A four-ring Ilizarov frame was applied, and two corticotomies were performed in a single sitting: (1) an oblique distal osteotomy to open-wedge correct valgus while permitting 1 mm day distraction and (2) a midshaft transverse osteotomy lengthened at 1 mm day. After 5 months, 12 cm of regenerated bone restored mechanical alignment and equalized limb length. The patient achieved full, painless knee and hip motion and resumed unrestricted play 7 months after frame removal. No deep infection, neurovascular injury, knee contracture, or regenerate fracture occurred.

CONCLUSION: The case illustrates that carefully planned, simultaneous deformity correction and lengthening can safely deliver length gains beyond those typically reported in single-level procedures while obviating multiple staged surgeries.