GeneralG24Malunionprinciplesandevaluation幻灯片.pptVIP

* 16 F, 2 years s/p Flex IMN for Proximal Third Femoral Fracture Short, Varus, Apex Anterior, Painful Lateral Thigh Deformity PRE OP PLAN 54 M, 13 years s/p Open tibial Fx Osteomyelitis Now, complaining of knee and tibial pain with activities Single Cut Osteotomy Osteotomy Fibula Lag screw compression Medial Plate Stabilization Multiplanar osteotomies Closed Femur IMN x 3ValgusShort 3.5 cm Planning Reduction 1 year post op IMN transverse osteotomy IMN, ORIF, Multiple Intramedullary Osteotomies Short 2.5 cm Painful Lateral Thigh Deformity IR Rotation Deformity 45° 2 Prior Failed ACL Recon Multiple Intramedullary Osteotomies Proximal Osteotomy Regenerate Recanalization Mid Mid Osteotomy Distal Osteotomy Translation ER Rotate Translate “Clamshell” osteotomy:G. Russell, MD “Clamshell” Osteotomy:G. Russell, MD “Clamshell” osteotomy:G. Russell, MD “Clamshell” osteotomy:G. Russell, MD “Clamshell” osteotomy:G. Russell, MD “Clamshell” osteotomy:G. Russell, MD Ilizarov Method Combination MethodOsteotomy, Derotation, Lengthening 45 M, Fall from ladder 18 mo prior Short Gamma IMN for Reverse Oblique Fx Pattern Began WBAT at 6 wks Complains of LLD (3.5 cm) and Inability to walk with his foot straight (45° ER Deformity) Remove IMN Ream CanalIntramedullary OsteotomyDerotate Leg – 45 Internal Rotation Insert IMN – No Dist ILApply Uniplanar Unicortical External FixatorBegin Distraction Osteogenesis When desired length obtained:Return to ORInsert Distal IL ScrewsRemove External Fixator Mid Ending Distraction Final Result End Result Complex problems Identify the problem Determine the consequences (with or without intervention) Plan the correction Execute the plan Lifelong learning Thank You E-mail OTA about Questions/Comments If you would like to volunteer as an author for the Resident Slide Project or recommend updates to any of the following slides, please send an e-mail to ota@aaos.org Return to General/Principles Index * * Malunions:Principles