Distal Femoral Osteotomy
In this article, we describe our most well-liked operative method for a lateral opening wedge varus-producing distal femoral osteotomy to correct mild to moderate valgus malalignment. Video 1 The video describes our most popular method for lateral opening wedge distal femoral osteotomy. PearlsRadiolucent retractors permit fluoroscopic visualization while the osteotomy is performed.The surgeon ought to mark the noticed 5-10 mm shorter than the length of the wire to keep away from 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 slow closing of the osteotomy gap ought to be carried out to avoid fracture of the lateral cortex.
Through appropriate indication and patient choice, each kinds of valgisation osteotomies near the knee joint can present improvements in medical perform, pain stage and high quality of life. These joint-preserving interventions thus symbolize a priceless treatment possibility in varus deformities. Varus deformities of the knee are regularly corrected by osteotomies, which should be performed on the stage of origin. But in contrast to excessive tibial osteotomies , little knowledge exists for distal femoral osteotomies . An Osteotomy is a controlled surgical break or fracture of the bone to allow realignment of the limb.
Dfo (distal Femoral Osteotomy)
Diagnostic arthroscopy can be utilized to evaluate for associated meniscoligamentous or cartilage accidents for concomitant procedures with the osteotomy. The denoted structures represent the lateral femoral condyle , the lateral meniscus , and the lateral tibial plateau . The goal of surgical procedure is to re-create neutral alignment, such that the mechanical axis line passes through the middle of the knee.3 The amount 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 edge to contemplate osteotomy.
- This article supplies a detailed, step-sensible technique that allows the reproducible creation of a medial closing-wedge DFO for the valgus knee utilizing locking-plate fixation.
- Typically, a extra lateral skin incision is made to achieve access to the lateral femoral cortex.
- Closure is then accomplished in layers with the medial patellofemoral ligament repaired if partially transected.
- Commonly, genu valgum occurs because of femoral malalignment and must be corrected with a DFO, whereas genu varum happens due to tibial malalignment and must be corrected with an HTO.
- The TomoFix medial distal femur anatomical plate was bent in accordance with the person’s anatomy and positioned under the vastus medialis muscle for osteotomy fixation .
Bone fusion is achieved and %MA is 48.5% from the medial fringe of the tibial plateau. Severe valgus deformity is noted with an FTA of a hundred and sixty levels and a %MA of 100% from the medial edge of the tibial plateau. Limitations of this examine are the heterogeneous study population and the low case number for femoral and tibial osteotomies. The anticipated variety of cases inside this cohort and the mean values and commonplace deviations in accuracy and medical outcome parameters in earlier studies had been too small for a prospective power evaluation. Additionally, lengthy-term details about medical perform or survival charges is missing. Several authors report an enchancment of medical scores for as much as 5 years postoperatively after HTO.