Corrective Osteotomy of the Distal Femur by Retrograde Nailing

Abstract

Deformities of the distal femur are usually corrected by supracondylar osteotomy. In the “classical” procedure the bone cut is performed with an oscillating saw, and internally fixed using a plate. This technique is hampered first by an invasive approach and second by limited corrective options in case of complex deformities. A supracondylar bone cut by focal dome osteotomy or drill osteoclasis in combination with internal fixation by retrograde intramedullary nailing (RN) might be a promising alternative procedure. 22 patients with multidimensional post-traumatic deformities of the distal femur were prospectively enrolled in a study to investigate this new minimally invasive technique. In all patients a meticulous analysis of leg geometry was done pre- and postoperatively. Details of operative planning, osteotomy and fixation procedure are given as well as the postoperative treatment. 13 corrective osteotomies were one-step procedures, in 9 patients additional lengthening over the RN was performed using unilateral external fixation. The mean follow-up was 35 (range 7-57) months. 19 of the osteotomies healed within the normally expected time frame. In 3 patients, all of them cigarette smokers, delayed bone healing demanded local revision and cancellous bone-grafting, in one patient a broken nail had to be replaced, additionally. All patients had important functional benefits. In 19 patients the goal of deformity correction was achieved. In one patient the correction in the frontal plane remained insufficient. In a second patient limb lengthening could not be completed due to scar tissue of the distal thigh. In a third patient an external torsional malalignment of + 27° after callus distraction demanded acute internal torsional correction. 6 months after the settlement of femoral lengthening osteomyelitis developed in one patient, probably due to a pin-track infection. The infection subsided after early removal of the RN. No further complications were observed. The presented technique is demanding concerning pre-operative planning and surgical realisation but it offers a minimally invasive and promising approach for the correction of multidimensional femoral deformities.

Key words

Deformity of distal femur - supracondylar corrective osteotomy - retrograde nailing - callus distraction

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