Percutaneous femoral shortening over a nail using on-site smashing osteotomy technique

Closed femoral-shortening osteotomy over an intramedullary nail for the treatment of leg length discrepancy (LLD) is a demanding surgical technique, classically requiring specialized instrumentation (intramedullary saw and chisel). Herein, we describe our experience with shortening osteotomy over a nail, using a percutaneous multiple drill-hole osteotomy technique to perform the bone section with the osteotomized bone smashed and let on-site. We operated on six patients with LLD due to: hemihypertrophy syndrome (three patients), congenital short femur, hemiplegic cerebral palsy, and growth plate injury. Mean femoral shortening was 4.2 cm. Osteotomy was performed via a multiple drill-hole technique, and femurs were stabilized using an intramedullary nail. Post-operative clinical and radiological data were recorded. Residual LLD was assessed through long-standing teleroentgenography. Shortening was achieved, with a final LLD of