Proximal Femoral Focal Deficiency Workup
- Author: Michael G Dennis, MD; Chief Editor: William L Jaffe, MD more...
Imaging Studies
- The Aitken classification, which is the most widely used classification, classifies proximal femoral focal deficiency into 4 categories based on the radiographic appearance.[14] Remember that late ossification may occur, whereby the bone may be present but not visualized radiographically. Occasionally, push-pull comparison radiographs, as well as abduction-adduction views, are necessary to distinguish between class A and class B. Arthrography also can be helpful.[7, 9, 19, 20]
Gillespie R, Torode IP. Classification and management of congenital abnormalities of the femur. J Bone Joint Surg Br. Nov 1983;65(5):557-68. [Medline].
Herzenberg JE, Branfoot T, Paley D, Violante FH. Femoral nailing to treat fractures after lengthening for congenital femoral deficiency in young children. J Pediatr Orthop B. Mar 2010;19(2):150-4. [Medline].
Chomiak J, Horák M, Masek M, Frydrychová M, Dungl P. Computed tomographic angiography in proximal femoral focal deficiency. J Bone Joint Surg Am. Aug 2009;91(8):1954-64. [Medline].
Aston WJ, Calder PR, Baker D, Hartley J, Hill RA. Lengthening of the congenital short femur using the Ilizarov technique: a single-surgeon series. J Bone Joint Surg Br. Jul 2009;91(7):962-7. [Medline].
Chomiak J, Podškubka A, Dungl P, Ošt'ádal M, Frydrychová M. Cruciate Ligaments in Proximal Femoral Focal Deficiency: Arthroscopic Assessment. J Pediatr Orthop. Jan 2012;32(1):21-28. [Medline].
Oppenheim WL, Setoguchi Y, Fowler E. Overview and comparison of Syme's amputation and knee fusion with the van Nes rotationplasty procedure in proximal femoral focal deficiency. In: Herring JA, Birch J, eds. The Child With a Limb Deficiency. Chicago, Ill:. American Academy of Orthopaedic Surgeons;1998.
Epps CH. Proximal femoral focal deficiency. J Bone Joint Surg Am. Jul 1983;65(6):867-70. [Medline].
Boden SD, Fallon MD, Davidson R. Proximal femoral focal deficiency. Evidence for a defect in proliferation and maturation of chondrocytes. J Bone Joint Surg Am. Sep 1989;71(8):1119-29. [Medline].
Panting AL, Williams PF. Proximal femoral focal deficiency. J Bone Joint Surg Br. Feb 1978;60(1):46-52. [Medline].
Koman LA, Meyer LC, Warren FH. Proximal femoral focal deficiency: a 50-year experience. Dev Med Child Neurol. Jun 1982;24(3):344-55. [Medline].
Aitken GT. Amputation as a treatment for certain lower-extremity congenital abnormalities. J Bone Joint Surg Am. Oct 1959;41-A:1267-85. [Medline].
Gillespie R. Classification of congenital abnormalities of the femur. In: Herring JA, Birch J, eds. The Child With a Limb Deficiency. Chicago, Ill:. American Academy of Orthopaedic Surgeons;1998.
Grogan DP, Holt GR, Ogden JA. Talocalcaneal coalition in patients who have fibular hemimelia or proximal femoral focal deficiency. A comparison of the radiographic and pathological findings. J Bone Joint Surg Am. Sep 1994;76(9):1363-70. [Medline].
Aitken GT. Proximal femoral focal deficiency-Definition, classification, and management. In: Aitken GT, ed. Proximal Femoral Focal Deficiency. A Congenital Anomaly. Washington, DC:. National Academy of Sciences;1969.
Amstutz HC. The morphology, natural history and treatment of proximal femoral focal deficiencies. In: Aitken GT, ed. Proximal Femoral Focal Deficiency. A Congenital Anomaly. Washington, DC:. National Academy of Sciences;1969.
Pappas AM. Congenital abnormalities of the femur and related lower extremity malformations: classification and treatment. J Pediatr Orthop. Feb 1983;3(1):45-60. [Medline].
Hamanishi C. Congenital short femur. Clinical, genetic and epidemiological comparison of the naturally occurring condition with that caused by thalidomide. J Bone Joint Surg Br. Aug 1980;62(3):307-20. [Medline].
Fixsen JA, Lloyd-Roberts GC. The natural history and early treatment of proximal femoral dysplasia. J Bone Joint Surg Br. Feb 1974;56(1):86-95. [Medline].
Maldjian C, Patel TY, Klein RM, Smith RC. Efficacy of MRI in classifying proximal focal femoral deficiency. Skeletal Radiol. Mar 2007;36(3):215-20. [Medline].
Bernaerts A, Pouillon M, De Ridder K, Vanhoenacker F. Value of magnetic resonance imaging in early assessment of proximal femoral focal deficiency (PFFD). JBR-BTR. Nov-Dec 2006;89(6):325-7. [Medline].
Griffith SI, McCarthy JJ, Davidson RS. Comparison of the complication rates between first and second (repeated) lengthening in the same limb segment. J Pediatr Orthop. Jul-Aug 2006;26(4):534-6. [Medline].
Wick JM, Alexander KM. Rotationplasty--a unique surgical procedure with a functional outcome. AORN J. Aug 2006;84(2):190-214; quiz 215-8. [Medline].
Fuchs B, Sim FH. Rotationplasty about the knee: surgical technique and anatomical considerations. Clin Anat. May 2004;17(4):345-53. [Medline].
Koman LA, Meyer LC, Warren FH. Proximal femoral focal deficiency: natural history and treatment. Clin Orthop. Jan-Feb 1982;(162):135-43. [Medline].
Alman BA, Krajbich JI, Hubbard S. Proximal femoral focal deficiency: results of rotationplasty and Syme amputation. J Bone Joint Surg Am. Dec 1995;77(12):1876-82. [Medline].
Friscia DA, Moseley CF, Oppenheim WL. Rotational osteotomy for proximal femoral focal deficiency. J Bone Joint Surg Am. Oct 1989;71(9):1386-92. [Medline].
Kostuik JP, Gillespie R, Hall JE, Hubbard S. Van Nes rotational osteotomy for treatment of proximal femoral focal deficiency and congenital short femur. J Bone Joint Surg Am. Dec 1975;57(8):1039-46. [Medline].
Borggreve J. Kniegelenksersatz durch das in der Beinlangsachse um 180 degree gedrehte fussgelenk. Arch Orthop. 1930;28:175-178.
Van Nes CP. Rotation-plasty for congenital defects of the femur. Making use of the shortened limb to control the knee joint of a prosthesis. J Bone Joint Surg. 1950;32B:12-16.
Fowler E, Zernicke R, Setoguchi Y, Oppenheim W. Energy expenditure during walking by children who have proximal femoral focal deficiency. J Bone Joint Surg Am. Dec 1996;78(12):1857-62. [Medline].
Steel HH, Lin PS, Betz RR, et al. Iliofemoral fusion for proximal femoral focal deficiency. J Bone Joint Surg Am. Jul 1987;69(6):837-43. [Medline].
Steel HH. Iliofemoral fusion for proximal femoral focal deficiency. In: Herring, JA, Birch J, eds. The Child With a Limb Deficiency. Chicago, Ill:. American Academy of Orthopaedic Surgeons;1998.
Brown KLB. Rotationplasty with hip stabilization in congenital femoral deficiency. In: Herring JA, Birch J, eds. The Child With a Limb Deficiency. Chicago, Ill:. American Academy of Orthopaedic Surgeons;1998.
Jones DC, Moseley CF. Subluxation of the knee as a complication of femoral lengthening by the Wagner technique. J Bone Joint Surg Br. Jan 1985;67(1):33-5. [Medline].

