Femoral Osteotomy

FEMORAL OSTEOTOMY REASON FOR VISIT: • • • • • • • • • • • • •

Nonunion of a femoral neck fracture Nonunion of an intertrochanteric hip fracture deformity Malunion of an intertrochanteric hip fracture deformity Frontal plane (varus/valgus) deformities Congenital coxa vara Varus fracture malunion Shepherd's crook deformity from fibrous dysplasia Significant shortening / bone loss of the distal femur requiring a proximal lengthening Hip osteoarthritis Hip osteonecrosis SCFE malunion Fibrous dysplasia Developmental dysplasia of the hip

RISK ASSESSMENT •Inflammatory arthritis •Advanced osteoarthritis •Advanced osteonecrosis •Bleeding disorders •Hypertension •Diabetes •Heart diseases •Renal disorders •Pulmonary insufficiency •Old age PREPARATION OF THE PATIENT: • •

Blood tests Urine tests

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X-ray chest ECG X-ray of o Standing anteroposterior pelvis radiographs o Cross-table lateral of the involved hip Standing bipedal 51-inch radiograph including the top iliac crests to below ankle joints to assess deformity and leg length Bone scanning CT scanning (Hip CT scan) MRI Aspirin was stopped Blood thinning medication was stopped before procedure Patient was on fasting for _____hrs before procedure Part was prepared and draped o

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ANESTHESIA: •General anesthesia POSITION OF THE PATIENT: •Supine position THE PROCEDURE INTERNAL FIXATION •Skin incision was given on lateral side of ___ thigh and extended the incision into subcutaneous tissue •_______ muscles were retracted •Blood vessels and nerves were protected form the injury •A Steinman pin was placed into the proximal femur posteriorly, at the level of the lesser trochanter. •A second pin was placed into the distal femur at an angle •Guide wire was placed for the blade plate into the femoral neck and head in the ____ __location.

•The seating chisel was advanced over the wire with taking care to enter the bone at the ideal angle in the sagittal plane. •Flexion / extension was done •The plate is then used to help obtain the correction. •The osteotomy was done at the level of the lesser trochanter. •Deformity was corrected •The screws were inserted through the plate. •Muscles were replaced •Drain was placed •Incision was closed in layers with _______ •Sterile dressing was applied EXTERNAL FIXATION •Percutaneous drilling was done •All half pins were inserted percutaneously •One half pin was placed centrally into the femoral neck and head. •An additional 1 to 2 pins were placed above the level of the lesser trochanter. •Three to 4 pins were placed in the shaft of the femur for stability. •One ring / ring block was attached to each segment to mimic the deformity. •A percutaneous osteotomy was done •The rings were manipulated to place the femur into the desired alignment. •The reduction was obtained by making the rings parallel. •The rings were then fixed to one another. •The skin incision was closed •Sterile dressing was applied FINDINGS: •Low intertrochanteric / subtrochanteric osteotomy / the lesser trochanter was done •Frontal plane (varus/valgus) deformity was found •Congenital coxa vara was found

•Varus fracture malunion •Shepherd's crook deformity from fibrous dysplasia •Hip osteoarthritis •Hip osteonecrosis •SCFE malunion •Fibrous dysplasia AFTER PROCEDURE: •Patient was shifted to intensive care unit •Heart rate, pulse rate, oxygenation, temperature was monitored. DURATION _____hrs POSTOPERATIVE CARE •Take antibiotics as prescribed •Take pain medication as prescribed •Clean the pinned area with normal saline COMPLICATIONS •Infection •Neurovascular injury •Nonunion •Inability to obtain or maintain a full correction •Persistence of pain postoperatively •Continued degeneration of hip articular cartilage •Deep vein thrombosis •Painful hardware •Pin site infection •Fracture above / below the frame •Fracture through a screw hole after frame removal, •Stiffness of adjacent joints

•Septic arthritis if pins communicate with the joint.