MINIMALLY INVASIVE COUNTER CORTICOTOMY OF THE DISTAL FEMUR IN PATIENTS WITH CONGENITAL LOWER LIMB DISORDERS (WITH PRESERVATION OF MEDULLARY CANAL STRUCTURES)
Abstract
The increasing demand for orthopaedic correction calls for the refinement of surgical techniques that maximize bone regeneration while minimizing iatrogenic trauma to the medullary canal. Aim of the study: to evaluate the outcomes of a novel dual-approach femoral corticotomy in patients with hypochondroplasia and achondroplasia. Materials and methods. A prospective dynamic active study enrolled 40 patients. The cohort was divided into a comparison group (Group 1, n=20) and a study group (Group 2, n=20), comprising pediatric patients aged 7-18 years with polysegmental deformities and lower limb shortening of genetic etiology. Group 1 underwent conventional single-approach corticotomy, while Group 2 received femoral corticotomy through two sequential approaches−minimally invasive counter corticotomy via anteromedial followed by anterolateral access−with mandatory final stabilization using an external fixation system with tension rods or hinge assemblies. Treatment outcomes were assessed according to four parameters: achieved segment lengthening, absence of residual deformity, preserved limb and joint function, and patient-reported satisfaction metrics. The study protocol received ethical approval from the Republican Specialized Scientific and Practical Medical Center of Traumatology and Orthopaedics (Approval No. 8-2023, dated 15 August, 2023). All procedures were conducted in accordance with the World Medical Association's Declaration of Helsinki (2000 amendments). Statistical analysis was performed using Microsoft Excel 2013. Given the sample sizes in the groups, non-parametric statistics were applied with a significance level set at p ≤ 0.05. Quantitative sample characteristics are presented in the table as the median (25th-75th percentiles) and the number of observations (n), corresponding to the number of step cycles. The statistical significance of differences was determined using the unpaired Wilcoxon test. Funding: This work was carried out within the framework of the research plan of the Bukhara State Medical Institute (05.2022 DSc.135) entitled “Development of new approaches to early diagnosis, treatment, and prevention of pathological conditions affecting the health of the population of the Bukhara region after COVID-19 (2022–2026)”. Results of the study. In Group 1 (n=20), where classical corticotomy in the distal third of the femur was performed via an anterolateral approach, outcomes were excellent in 85% of patients, good in 5%, and satisfactory in 10%. In Group 2 (n=20), where a dual-approach counter corticotomy preserving the medullary canal was used, outcomes were excellent in 90%, good in 5%, and satisfactory in 5%. Conclusion. Both techniques achieved careful preservation of the medullary canal structures and yielded a high rate of satisfactory outcomes. The novel dual-approach femoral corticotomy proved to be a viable and effective alternative to the classical technique for patients with hypochondroplasia and achondroplasia.