Congenital Femoral Deficiency: Paley Type 2c

Congenital femoral deficiency (CFD) is a spectrum of severity of femoral deficiency and deformity. Deficiency implies a lack of integrity, stability, and mobility of the hip and knee joints. Deformity refers to bone malorientation, bone malrotation, and soft tissue contractures of the hip and knee. Both deficiencies and deformities are present at birth, nonprogressive, and of variable degree (Paley D, Standard SC Lengthening reconstruction surgery for congenital femoral deficiency. In: Rozbruch SR, Ilizarov S (eds) Limb lengthening and reconstruction surgery, ch 29. Informa Healthcare, New York, pp 393–428, 2007). The Paley classification system is based on the factors that influence lengthening reconstruction of the congenitally short femur. Type 2 has a mobile proximal femur with a mobile knee. The previous classification had only 2a and 2b which both had a mobile pseudarthrosis. Type 2b included fused and absent femoral head. Since the SuperHip (SH) 2 procedure (see Chap. 31, “Congenital Femoral Deficiency: Paley Type 2a”) can be done for some type 2bs, I separated it into type 2c where there is no femoral head. Paley type 2c have a greater trochanter present but no femoral head. The treatment for type 2b fused femoral heads that are not candidates for SH2, and for cases that have no femoral head, what I now refer to as 2c, is a pelvic support osteotomy.