Corrective Osteotomy of the Distal Femur by Retrograde Nailing

Abstract

Objective:

Correction of deformities of distal femur by a supracondylar dome or drill hole osteotomy in combination with a retrograde intramedullary nailing as an alternative to the classic technique of osteotomizing with an oscillating saw and internally fixating with a blade plate. In addition, leg length discrepancies can be corrected by the use of a unilateral distraction fixator after correction of axial and torsional deformities.

Indications:

Multidimensional deformities of the distal femur. Deformities of the distal femur with shortening > 1.5 cm. Deformities of the distal femur in the presence of length discrepancy and torsional deformity of the lower leg. Distal femoral deformities that may later need to be treated with a total knee replacement.

Contraindications:

State after local bone or soft tissue infections. A condylar bone stock insufficient for purchase of screws for intramedullary locking.

Surgical Technique:

Knee arthroscopy. Determination of the entry point and direction of insertion of the intramedullary nail in the frontal and sagittal plane. Insertion of the nail up to the level of osteotomy, placement of Schanz screws proximal and distal to the planned osteotomy for later assessment of the degree of correction. Either dome os teotomy or drill hole osteotomy. Correction of axial and torsional malalignments. Advancing of nail and static locking. Optional: for intended callus distraction, mounting of a unilateral distraction fixator.

Results:

Follow-up after 29 (4–45) months of 18 patients, seven with callus distraction. The goal of correction was reached in 17 patients. Three nonunions and one osteomyelitis healed after surgical revision.