In this article, we describe our preferred operative method for a lateral opening wedge varus-producing distal femoral osteotomy to correct delicate to moderate valgus malalignment. Video 1 The video describes our most popular technique for lateral opening wedge distal femoral osteotomy. PearlsRadiolucent retractors permit fluoroscopic visualization whereas the osteotomy is carried out.The surgeon should mark the noticed 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 sluggish closing of the osteotomy hole must be carried out to avoid fracture of the lateral cortex.
For a medial closing wedge osteotomy, a wedge-formed part of bone is eliminated, and the opening is closed by bringing the reduce ends of the bones collectively, thus altering the alignment of the bones. We have discovered that performing the distal femoral osteotomy and the MCL reconstruction on the identical time is successful and doesn’t require two separate reconstructions. Calculations of the specific amount of opening that is wanted using the present digital x-ray techniques are very accurate. Concurrent with this, a plate and screws are positioned on the outside of the knee and bone graft is placed into the opening wedge which is created to help with healing of the hole. The wedge size may also be deliberate before surgical procedure and confirmed intraoperatively.
Femoral Distal Opening And Shutting Wedge Osteotomy :
In the case of lateral compartment osteoarthritis we carry out an osteotomy in the femur to realign the knock knee to being more straight or even slightly bow legged. Patients with lateral compartment arthritis normally complain of pain and stiffness across the knee. They typically level to the outer aspect of the knee as the primary focus of their pain. The knee can swell up particularly after strenuous activity and some sufferers will note grinding or locking of their knee. Depending upon the diploma of severity of the symptoms they could have difficulty doing their usual sporting actions such as running, or strolling so far as regular. In common, sufferers who wish to stay comparatively excessive impact, especially laborers or patients who’re nonetheless fairly lively, or in youthful patients, a distal femoral osteotomy would be most popular over a total knee substitute.
- The approach presented in this article provides a safe, reproducible methodology to perform the medial closing-wedge DFO.
- The success charges for lateral meniscal transplants and cartilage resurfacing procedures are much much less if the valgus alignment isn’t corrected with the surgical process .
- Corticocancellous wedges are harvested from the femoral neck portion of an allograft femoral head and placed into the osteotomy web site according to the preoperative plan.
- The diaphyseal midline was marked with an electrocautery and a Codman pen to keep away from angular deviation during the stabilization of the plaque.
Bone fusion is achieved and %MA is forty eight.5% from the medial edge of the tibial plateau. Severe valgus deformity is noted with an FTA of one hundred sixty levels and a %MA of one hundred% from the medial edge of the tibial plateau. Limitations of this study are the heterogeneous study inhabitants and the low case quantity for femoral and tibial osteotomies. The anticipated variety of instances within this cohort and the imply values and standard deviations in accuracy and medical end result parameters in earlier studies have been too small for a potential energy evaluation. Additionally, lengthy-time period details about scientific function or survival rates is missing. Several authors report an enchancment of clinical scores for up to 5 years postoperatively after HTO.