AP radiograph of the lower extremities (image 1) and pelvis | Figure 1

CincyKidsRad

Cincinnati Children's Radiology

AP radiograph of the lower extremities (image 1) and pelvis (image 2) obtained in a patient with proximal focal femoral deficiency shows an abnormal configuration of the femurs. The femurs are shortened with a hypoplastic femoral head and neck. The femurs are displaced superiorly and the acetabula are dysmorphic. Proximal focal femoral deficiency is a disorder characterized by the absence of a variable portion of the femur. The Aitken classification system is most widely used and divides the deformity into four types. #MSKMonday #MusculoskeletalMonday

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Lateral radiograph (image 1), coronal (image 2), and axial (image 3) CT of the femur show a comminuted open fracture of the distal femoral diaphysis. A soft tissue laceration (arrow) is visible. Open fractures are present anytime a skin laceration is present in the setting of a fracture. Because the bone is exposed to air, the patient is at risk for infection and should be treated as if they have osteomyelitis.](https://app.figure1.com/case-detail/026702ed-df8a-4865-bb41-51920b32d7df)


Radiograph of the lower extremities shows findings of proximal focal femoral deficiency with an abnormal appearance of the right femur (arrowhead, image 2) and irregularity of the right femoral head. In addition, there is calcinosis at the knee joint (arrow, image 2). Proximal focal femoral deficiency is a malformation of growth and development of the lower extremity associated with four major biomechanical problems: hip instability, malrotation of the thigh, deficient proximal musculature, and a leg length discrepancy. #MSKMonday #MusculoskeletalMonday](https://app.figure1.com/case-detail/125b8214-7984-4432-8f54-b2ab58d6aa6c)


Frog-leg (image 1) and AP (image 2) radiograph of the pelvis highlighting the left hip shows an abnormal left acetabulum, abnormal valgus configuration of the hip. It is uncertain whether the femur is completely absent or the proximal portion represents a dysmorphic femur articulating with the tibia giving an appearance of the femoral neck. Fibular hemimelia is also present. Overall, the findings on the leg length discrepancy radiograph (prior case) and hip radiographs highlight findings related to a variant of proximal focal femoral deficiency. Proximal focal femoral deficiency represents variable absence of the femur. There are a number of classification systems for proximal focal femoral deficiency. The Aitken classification system has for classes ranging from Class A with a shortened femur to class D with absence of the acetabulum and proximal femur.](https://app.figure1.com/case-detail/20962188-e17b-4508-a4d5-c4a435a091eb)


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