Sei sulla pagina 1di 4

AO Surgery Reference X Cha

PD
F-

ng

http://www2.aofoundation.org/wps/portal/!ut/p/c1/04_SB8K8xLLM9... X Cha
PD
F-

ng

O W !

bu

to

lic

lic

to

bu

N
.c

O W !
w
.d o

.d o

c u -tr a c k

c u -tr a c k

.c

close window Proximal femur Options Author Femur Links to other chapters Bibliography Author Ren K Marti Femur Femur, proximal In the presence of a malunion of the proximal femur with normal hip movement, the intertrochanteric osteotomy restores the correct biomechanical situation in all planes [1, 911]. Special indications may be the correction of leg length discrepancies by shortening or lengthening. In the presence of a malunion of the proximal femur with normal hip movement, the intertrochanteric osteotomy restores the correct biomechanical situation in all planes [1, 911]. Special indications may be the correction of leg length discrepancies by shortening or lengthening. Preoperative planning is based on AP and lateral x-rays of the proximal femur and the calculation of all correction angles, including the gain of leg length by valgisation (open or closed wedge osteotomy). Valgisation should restore the biomechanical balance, but on the other hand, to avoid an abduction contracture the amount of correction is limited by current hip function.

Intertrochanteric valgisation osteotomy for varus deformity after femoral neck fracture. Lateral approach; placement of K-wires for the control of anteversion, rotation, and the

1 of 4

16/01/2006 0:34

w
w

w
w

AO Surgery Reference X Cha


PD
F-

ng

http://www2.aofoundation.org/wps/portal/!ut/p/c1/04_SB8K8xLLM9... X Cha
PD
F-

ng

O W !

bu

calculated angle for the seating chisel.


w
w

to

lic

lic

to

bu

N
.c

O W !
w
.d o

.d o

c u -tr a c k

a Introduction of the seating chisel, osteotomy more or less parallel to the chisel,
o

c u -tr a c k

.c

creating a large bony surface; stepwise removal of a lateral wedge. b Introduction of a 120 angled blade plate after repeated reduction using the seating chisel as lever arm until the calculated correction is achieved without creating an abduction contracture. c Stabilization of the osteotomy with compression using the tension band principle. The medial defect is filled with the removed wedge. The universal implant is the condylar blade plate. Depending on the amount of valgisation, a 95 angled blade plate can easily be bent to any desired angle, the 120 and 130 angled blade plates are useful for special indications (malunion and nonunion of the femoral neck). An intramedullary nail with locking option nail does not allow precise correction of complex deformities but may be indicated for purely rotational deformities. The postoperative treatment is usually functional with 8 weeks of partial weight bearing. Subtrochanteric osteotomy in different planes to correct a malunion and shortening: The indication for this surgery is a leg length discrepancy in combination with other malalignments of the proximal femur. This osteotomy is technically demanding and experience in individual contouring of plates is required (Fig 5.1-9). Lengthening and reduction can be difficult; temporary interposition of artificial bone blocks may be helpful before interposing autogenous bone grafts [11].

3-D subtrochanteric osteotomy of the proximal femur (valgisation, rotation, lengthening). a Placement of the seating chisel and adaptation of the osteotomy plane, respecting the desired corrections. b Distraction with a strong bone spreader with the plate in situ. c Interposition of corticocancellous bone grafts (from the ipsilateral iliac crest), internal fixation with contoured 95 condylar plate or a 6-hole 90angled blade plate.

2 of 4

16/01/2006 0:34

w
w

AO Surgery Reference X Cha


PD
F-

ng

http://www2.aofoundation.org/wps/portal/!ut/p/c1/04_SB8K8xLLM9... X Cha
PD
F-

ng

O W !

bu

to

lic

lic

to

bu

N
.c

O W !
w
.d o

.d o

c u -tr a c k

c u -tr a c k

.c

3-D subtrochanteric osteotomy of the proximal femur (valgisation, rotation, lengthening). df Clinical case: d Slight varus, shortening, and extreme malrotation after intramedullary nailing of a femoral shaft fracture in a 24-year-old female. e 50 derotation, 10 valgisation, and 1.6 cm lengthening; stable fi xation with a condylar plate. f Consolidated corrective osteotomy after implant removal. Subtrochanteric shortening to establish equal leg length [1, 11]: This is a low-risk operation for shortening of up to 5 cm; only one nonunion in 70 cases was observed. Preoperative planning is extremely important. The plate has to fit the greater trochanter and the femur exactly in order to achieve adequate contact and to avoid fracture of the lesser trochanter. Links to other chapters Malunion: principles Malunion: proximal humerus Malunion: humeral shaft Malunion: distal humerus Malunion: distal radius Malunion: proximal femur Malunion: femoral shaft Malunion: distal femur Malunion: proximal tibia Malunion: distal tibia Malunion: malleoli Bibliography [1] Mller ME, Allgwer M, Schneider R, et al (1979) Osteotomies. Mller ME, Allgwer M, Schneider R, et al (eds), Manual of Internal Fixation. Techniques recommended by the AO-ASIF Group. 2nd ed. Berlin Heidelberg New York: Springer-

3 of 4

16/01/2006 0:34

w
w

w
w

AO Surgery Reference X Cha


PD
F-

ng

http://www2.aofoundation.org/wps/portal/!ut/p/c1/04_SB8K8xLLM9... X Cha
PD
F-

ng

O W !

bu

Verlag.
w
w

to

lic

lic

to

bu

N
.c

O W !
w
.d o

.d o

c u -tr a c k

[2] Mast J, Jakob R, Ganz R (1989) Osteotomies. Mast J, Jakob R, Ganz R (eds),
o

c u -tr a c k

.c

Planning and Reduction Technique in Fracture Surgery. 1st ed. Berlin Heidelberg New York: Springer-Verlag, 1215. [3] Staubeli A, De Simoni C, Babst R, et al (2003) Tomofix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia early results in 92 cases. Injury; 34(Suppl 2):5562. [4] Sangeorzan BJ, Sangeorzan BP, Hansen ST Jr, et al (1989) Mathematically directed single-cut osteotomy for correction of tibial malunion. J Orthop Trauma; 3(4):267275. [5] Meyer DC, Siebenrock KA, Schiele B, et al (2005) A new methodology for the planning of single-cut corrective osteotomies of mal-aligned long bones. Clin Biomech; 20(2):223227. [6] Marti RK, Ochsner PE, Bernoski FP (1981) [Correction osteotomy of the distal humerus in adults.] Orthopade; 10(4):311315. [7] Fernandez DL (1982) Correction of post-traumatic wrist deformity in dults by osteotomy, bone-grafting, and internal fixation. J Bone Joint Surg Am; 64(8):11641178. [8] Fernandez DL, Jupiter JB (1995) Malunion of the distal end of the radius. Fernandez DL, Jupiter JB (eds), Fractures of the distal radius: diagnosis and treatment. Berlin Heidelberg New York: Springer-Verlag, 263315. [9] Schatzker J (1984) The Intertrochanteric Osteotomy. 1st ed. Berlin Heidelberg New York: Springer-Verlag. [10] Bombelli R (1976) Osteoarthritis of the Hip. 1st ed. Berlin Heidelberg New York: Springer-Verlag. [11] Marti RK (1993) Osteotomies in posttraumatic deformities following fractures of the proximal femur. Marti RK, Dunki Jakobs PB (eds), Proximal Femoral Fractures, Operative Techniques and Complications; Vol. 2. 1st ed. London: Medical Press Ltd, 573587. [12] Weber BG (1981) Lengthening osteotomy of the fibula to correct a widened mortice of the ankle after fracture. Int Orthop; 4(4):289293. [13] Marti RK, Raaymakers EL, Nolte PA (1990) Malunited ankle fractures. The late results of reconstruction. J Bone Joint Surg Br; 72(4):709713. close window

4 of 4

16/01/2006 0:34

w
w