Treatment Strategies

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At the Paley Institute, we treat the orthopedic manifestations of Nail-Patella Syndrome, namely deformities and deficiencies in the knee, elbow, hip, and ankle joints.

The primary complaint of those with Nail Patella Syndrome is the deformity of the knee, specifically the dislocation of the patella. To correct this, Dr. Paley will first reduce the tibia on the fibula with application of an external fixator. A circular external fixator (Ilizarov or TSF) is preferred since it can perform three-dimensional correction.

After reduction of the tibia, Dr. Paley will perform the second stage surgery: an intra-articular osteotomy (surgical bone cut) to elevate the tibial plateau. A bone graft is inserted as well as an internal plate to hold the alignment in place. This will stabilize the knee joint.

Patients often have significant muscle contractures of the knees as well, which can be corrected with muscle releases. Gradual distraction with the external fixator will also slowly correct the contractures. The external fixator can also be used to lengthen the tibia and / or femur to correct any limb length discrepancy.

A similar approach can be performed on other joints that may be deficient due to Nail Patella Syndrome. The treatment strategy will follow these steps:

  1. Gradual distraction of the affected joint with external fixator
  2. Osteotomy to correct and realign the joint
  3. Soft tissue releases to correct contractures
  4. Limb lengthening to correct limb length discrepancies

For more information, see Limb Lengthening Center

At the Paley Institute, we have successfully performed limb deformity correction and limb lengthening on patients with Nail Patella Syndrome, with excellent results.