Corrective osteotomies of the distal femur by retrograde nailing

Deformities of the distal femur are usually corrected by supracondylar oste otomy. In the "classical" procedure the bone cut is performed with an oscil lating saw, and internally fixed using a plate. This technique is hampered first by an invasive approach and second by limited corrective options in c ase of complex deformities. A supracondylar bone cut by focal dome osteotomy or drill osteoclasis in co mbination with internal fixation by retrograde intramedullary nailing (RN) might be a promising alternative procedure. 12 patients with multidimension al post-traumatic deformities of the distal femur were prospectively enroll ed in a study to investigate this new minimal-invasive technique. In all pa tients a meticulous analysis of leg geometry was done pre- and postoperativ ely. Details of operative planning, osteotomy and fixation procedure are gi ven as well as the postoperative treatment. 7 corrective osteotomies were o ne-step procedures, in 5 patients additional lengthening over the RN was pe rformed using unilateral external fixation. The mean follow-up was 15 (range 7-27) months. All of the osteotomies heale d in a normal expected time frame. All patients had important functional be nefits. In 11 patients the goal of deformity correction was achieved. In on e patient the correction in the frontal plane remained insufficient. 6 mont hs after the completion of femoral lengthening osteomyelitis developed in o ne patient, probably due to a pin-track infection. The infection subsided a fter early removal of the RN. No further complications were observed. The presented technique is demanding concerning pre-operative planning and surgical realization but it offers a minimal-invasive and promising approac h for the correction of multidimensional femoral deformities.