Decortication and osteotomy for the correction of multiplanar deformity in the treatment of malunion in adult diaphyseal femoral deformity: a case series and technique description

Electromagnetic Navigation Assisted Patient-Personalized Femoral Osteotomy for Acute Correction of Posttraumatic Residual Multiplanar Femoral Deformity with Shortening

Improper healing of a femoral shaft fracture can result in posttraumatic residual multiplanar femoral deformity and limb shortening, which can be restored with a corrective osteotomy. Predominantly in complex posttraumatic circumstances, the use of computer assistance in orthopaedic surgery may facilitate meticulous preoperative planning, and further improve the accuracy and safety of such procedures, potentially resulting in better clinical outcomes. Herein, we present a unique case of electromagnetic navigation assisted patient-personalized femoral osteotomy for acute correction of posttraumatic residual multiplanar femoral deformity with shortening.

Femoral-tibial contact stresses on fixed rotational femur models

Objectives

This study aims to quantitatively evaluate the femoral-tibial contact pressure on the knee under certain malrotaional degrees.

Methods

Femoral-tibial contact pressure was carried out on 14 fixed rotational knee models under 200/400/600 N vertical load using ultra-low-pressure sensitive film technology, rotation angles including neutral position (0°, anatomically reduced), 5°, 10°, and 15° internally and externally. Data were collected and analyzed with SPSS software.

Results

There are significant statistical differences between the medial contact pressure among rotational deformities (including neutral position) (P < 0.01), the increase in the degree of fixed internal malrotation of the femur resulted in a linear increase in the medial femoral-tibial contact pressures (P < 0.05) under 200/400/600 N vertical load, while increase in the degree of fixed external malrotation resulted in a linear decrease (P < 0.05). Except the 200 N compression, we can't find significant differences in lateral contact pressures (P > 0.05). In the comparison of medial to lateral contact pressures, no statistically significant differences were found in neutral and 5° internal rotation under 200/400 N, neutral, 5° internal rotation, and 15° external rotation under 600 N. In contrast, medial contact pressures were higher than lateral at other angles (P < 0.05).

Conclusion

Obvious contact pressure changes were observed in rotatory femur. Doctors should detect rotational deformity as much as possible during operation and perform anatomical reduction. For patients with residual rotational deformities, indication of osteotomy should not be too broad.

Acute Femoral Lengthening in Adults Using Step-Cut Osteotomy, Traction Table, and Proximal Femoral Locking Plate Fixation: Surgical Technique and Report of Three Cases

INTRODUCTION

Leg-length discrepancy (LLD) can cause distinct gait and posture disorders that may lead to lifestyle-limiting disability and premature joint degeneration. The purpose of this study was to describe a novel surgical method for acute femoral lengthening in adults with symptomatic structural LLD using step-cut osteotomy, traction table, and proximal femoral locking plate fixation.

MATERIALS AND METHODS

We retrospectively evaluated three consecutive adult patients that underwent the procedure at our institution between 2011 and 2019, describing the surgical technique and presenting a report of three cases, including complications assessment.

RESULTS

The average age was 47 years (range 38-58), average BMI was 28.1 kg/m² (range 26.8-29.9), average ASA score was 2 (range 1-3). The mean pre-operative shortening (2 congenital, 1 posttraumatic) was 21 mm (range 20-23). The average elongation achieved was 18 mm (range 15-20). The average surgery duration was 142 min (range 120-165) and the average estimated blood loss was 558 mL (range 375-900). Symptoms were relieved after the lengthening in all three cases. We observed no complications after the mean 68 months (range 22-125) of follow-up.

CONCLUSIONS

Successful correction of structural LLD is challenging, depends on patient selection, meticulous planning, surgical technique and experience. Therefore, it should be considered case-by-case. In the hands of an experienced surgeon, our method of acute femoral lengthening seems safe and suitable for carefully selected cases of structural LLD correction, where the final lengthening goal remains within the critical limits of one-stage leg lengthening and principles of traction table use.