Paley Classification
Type 1: intact femur with mobile hip and knee         a) normal ossification of the proximal femur           b) delayed ossification of the proximal femur
Type 3: diaphyseal deficiency of the femur a) knee motion >45° b) knee motion <45°
A. Standing anteroposterior view radiograph of a 2-year-old boy with Paley type 1 congenital femoral deficiency (limb length discrepancy = 7 cm) and coxa vara. The neck shaft angle = 95° relative to the proximal shaft of the femur. The proximal femoral physis is relatively horizontally inclined. There is a diaphyseal varus of 20°.	B. Treatment by proximal femoral valgus external rotation osteotomy. The proximal coxa vara was not corrected, but the diaphyseal varus was corrected. The lengthening is performed through a distal femoral osteotomy. The lengthening is being performed with an Ilizarov apparatus. The external fixation extends to the tibia, with hinges to allow for knee motion.	C. Final standing anteroposterior view radiographs obtained after limb lengthening (7 cm).
D. Clinical photographs obtained when the patient was 7 years old. He underwent growth stimulation after lengthening and had a 1.5-cm leg length discrepancy at age 7 years. E. Clinical photograph shows maximum knee flexion at age 7 years.
A. Anteroposterior view radiograph of the pelvis in a 3-year-old girl shows that the center edge angle = 11° on the short side and 15° on the long side. Both sides are dysplastic. The minimal normal center edge angle that is safe for lengthening is 20°. B. Anteroposterior view radiograph of pelvis shows that the center edge angle = 35° after a Dega osteotomy that was performed before lengthening of the femur.

Read Lengthening Reconstruction Surgery for Congenital Femoral Deficiency (PDF)  by Dror Paley, M.D.

The International Center for Limb Lengthening
Sinai Hospital of Baltimore
2401 West Belvedere Avenue
Baltimore, Maryland 21215, USA
phone: 410-601-8700
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