Distal Femoral Osteotomy
In this article, we describe our most well-liked operative method for a lateral opening wedge varus-producing distal femoral osteotomy to appropriate gentle to average valgus malalignment. Video 1 The video describes our most well-liked method for lateral opening wedge distal femoral osteotomy. PearlsRadiolucent retractors enable fluoroscopic visualization whereas the osteotomy is performed.The surgeon ought to mark the saw 5-10 mm shorter than the size of the wire to avoid plunging and violating the lateral cortex. Two separate marks could also be used to correspond to the lengths of the anterior and posterior wires, respectively.Gentle and/or gradual closing of the osteotomy gap must be performed to keep away from fracture of the lateral cortex.
Through acceptable indication and affected person selection, both kinds of valgisation osteotomies close to the knee joint can present enhancements in scientific operate, pain degree and high quality of life. These joint-preserving interventions thus characterize a priceless remedy option in varus deformities. Varus deformities of the knee are frequently corrected by osteotomies, which ought to be carried out on the level of origin. But in contrast to high tibial osteotomies , little knowledge exists for distal femoral osteotomies . An Osteotomy is a managed surgical break or fracture of the bone to allow realignment of the limb.
Femoral Distal Opening And Closing Wedge Osteotomy :
Diagnostic arthroscopy can be utilized to assess for associated meniscoligamentous or cartilage injuries for concomitant procedures with the osteotomy. The denoted structures represent the lateral femoral condyle , the lateral meniscus , and the lateral tibial plateau . The goal of surgical procedure is to re-create neutral alignment, such that the mechanical axis line passes through the center of the knee.three The quantity of correction is calculated based mostly on the angle formed between the mechanical axis of the femur and tibia . Practically, 5 degrees of malalignment is the brink to think about osteotomy.
- There had been no related differences in hospital keep, blood loss or surgical procedure time.
- The approach offered on this article provides a safe, reproducible method to perform the medial closing-wedge DFO.
- Corticocancellous wedges are harvested from the femoral neck portion of an allograft femoral head and positioned into the osteotomy web site in accordance with the preoperative plan.
- The diaphyseal midline was marked with an electrocautery and a Codman pen to avoid angular deviation through the stabilization of the plaque.
Bone fusion is achieved and %MA is 48.5% from the medial edge of the tibial plateau. Severe valgus deformity is noted with an FTA of a hundred and sixty degrees and a %MA of 100% from the medial edge of the tibial plateau. Limitations of this examine are the heterogeneous research inhabitants and the low case quantity for femoral and tibial osteotomies. The anticipated number of cases inside this cohort and the imply values and standard deviations in accuracy and clinical outcome parameters in earlier studies have been too small for a prospective energy evaluation. Additionally, lengthy-time period details about scientific function or survival charges is lacking. Several authors report an improvement of clinical scores for as much as 5 years postoperatively after HTO.