25. CLOSED CORRECTIVE ROTATION OSTEOTOMY OF THE FEMUR USING AN ENDOMEDULLARY SAW: 11 CASES

Abstract

Purpose of the study: The purpose of this retrospective work was to analyse a series of ten patients (11 osteotomies) who underwent closed rotation osteotomy of the femur performed with an endomedullary saw and stabilized with a centromedullar locked nail. We identified the proper indications, technical aspects, clinical and radiological outcome and describe the complications of this surgical technique.

Material and method: The 11 osteotomies were performed in ten patients from January 1999 to July 2007 for post-trauma rotation defects or congenital deformity. On average the rotation defect was 33.5 (range 24–52), mainly internal rotation (10 cases versus 1 with external rotation). One female patient required a bilateral procedure in a context of congenital bilateral trochlea dysplasia. For two other patients the corrective osteotomy was associated with a lengthening procedure performed during the same operative time (totally closed operation). Clinical and radiological follow-up was available to 4 years 9 months on average (range 26–104 months). The angle corrections were determined on bone tomographs.

Results: Ten of the 11 osteotomies yielded correction to ±4° physiological values (or controlateral values if the other side was healthy) for anteversion of the femoral neck. There were no infections (bone, joint, skin, soft tissue) and not late healing or non-union. There was one transient neurological complication involving the pudendal nerve during a rotation-lengthening procedure and one bilateral fracture of the femur during a bilateral osteotomy. All patients healed within 3 to 5 months. Subjective outcome was satisfactory very satisfactory for 8 of 9 patients (one lost to follow-up) in terms of functional recovery and aesthetic aspect of the scars.

Discussion: The closed procedure for rotation osteotomy of the adult femur is a reliable, effective, safe and reproducible technique for the correction of rotation defects of the femur resulting from trauma or congenital disorders. These results can be obtained only with rigorous technique requiring experience and skill with centromedullary nailing.