Distal Femoral Osteotomy
In this text, we describe our most popular operative approach for a lateral opening wedge varus-producing distal femoral osteotomy to right mild to reasonable valgus malalignment. Video 1 The video describes our preferred approach for lateral opening wedge distal femoral osteotomy. PearlsRadiolucent retractors enable fluoroscopic visualization whereas the osteotomy is performed.The surgeon should mark the saw 5-10 mm shorter than the length of the wire to avoid plunging and violating the lateral cortex. Two separate marks may be used to correspond to the lengths of the anterior and posterior wires, respectively.Gentle and/or sluggish closing of the osteotomy hole should be carried out to keep away from fracture of the lateral cortex.
For a medial closing wedge osteotomy, a wedge-formed section of bone is eliminated, and the opening is closed by bringing the minimize ends of the bones collectively, thus changing the alignment of the bones. We have discovered that performing the distal femoral osteotomy and the MCL reconstruction on the same time is successful and doesn’t require two separate reconstructions. Calculations of the specific quantity of opening that is wanted using the current digital x-ray systems 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 gap. The wedge dimension may also be deliberate earlier than surgical procedure and confirmed intraoperatively.
Dfo (distal Femoral Osteotomy)
Diagnostic arthroscopy can be used to assess for associated meniscoligamentous or cartilage injuries for concomitant procedures with the osteotomy. The denoted structures symbolize the lateral femoral condyle , the lateral meniscus , and the lateral tibial plateau . The goal of surgery is to re-create neutral alignment, such that the mechanical axis line passes via the middle 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 have been no relevant variations in hospital stay, blood loss or surgical procedure time.
- The approach presented on this article offers a protected, reproducible methodology to carry out the medial closing-wedge DFO.
- The success charges for lateral meniscal transplants and cartilage resurfacing procedures are a lot much less if the valgus alignment is not corrected with the surgical process .
- Corticocancellous wedges are harvested from the femoral neck portion of an allograft femoral head and positioned into the osteotomy web site based on the preoperative plan.
- Among them, Salter-Harris kind II is the most typical, making up about half of growth plate fractures, whereas types IV and V are uncommon, accounting for only some percent .
- The diaphyseal midline was marked with an electrocautery and a Codman pen to keep away from angular deviation in the course of the stabilization of the plaque.
Sports-related injuries and motorized vehicle accidents are presently the commonest causes of damage. Proper care of these accidents consists of counseling patients and fogeys relating to the longer term chance of progress-related complications. Among them, Salter-Harris kind II is the commonest, making up about half of progress plate fractures, whereas varieties IV and V are rare, accounting for only some p.c . Distal femoral perichondral ring harm (SH sort VI, Rang’s type VI) is a comparatively rare damage and is understood to lead to a excessive prevalence of progress disorders with angular deformity . However, the timing of therapy and approaches to remedy have but to be established.