Work

Management of proximal femoral focal deficiency with limited resources amid war in a child with multiple skeletal deformities: a case report

Year: 2026

Type: article

Abstract: Introduction and Importance: Proximal femoral focal deficiency is a rare congenital anomaly marked by underdevelopment of the proximal femur, frequently presenting with limb-length discrepancy and functional limitation. Management is particularly challenging in conflict-affected, low-resource settings where diagnostic and therapeutic resources are limited. Case Presentation: An 18-month-old female presented with progressive limb-length discrepancy and abnormal gait. Radiographs showed shortened proximal femur, complete left fibular absence, tibial bowing and shortening, calcaneovalgus deformity, and loss of the fifth ray. A staged surgical plan included femoral lengthening with a monoaxial external fixator, tibial lengthening and alignment correction with an Ilizarov frame, and subsequent pelvic and tibial corrective osteotomies. Each stage was followed by structured physiotherapy. Discussion: Despite wartime resource constraints, phased reconstruction reduced discrepancy and improved gait by combining established limb-reconstruction techniques with context-sensitive adaptations. Conclusion: Strategic, staged reconstruction can deliver meaningful functional outcomes for complex congenital limb anomalies even in severely resource-limited settings.

Source: International Journal of Surgery Case Reports

DOI: 10.1097/rc9.0000000000000288

Authors: Thaer Kadora, Hussein Debsawi, Hassan Debsawi, Ahmad Hanino, Abdulhakim Alatrash

Institution: University of Aleppo

Language: English

Topic: Congenital limb and hand anomalies

Subfield: Developmental Biology

Field: Biochemistry, Genetics and Molecular Biology

Domain: Life Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,090