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.