Rotational femoral osteotomies using an endomedullary saw.
BACKGROUND
The goal of this retrospective study is to analyze a series of ten patients (11 osteotomies) who underwent closed femoral rotational osteotomy using an endomedullary saw; stabilization was achieved by a locked centromedullary nail. We report the indications, technical aspects, clinical and radiological results as well as intercurrent complications with this surgical technique.


OBJECTIVE
Femoral endomedullary osteotomy is a safe procedure to correct malrotations.


METHODS
Eleven femoral rotational osteotomies using an endomedullary saw were performed on ten patients, between January 1999 and July 2007. The indications were post-traumatic rotational malunions or congenital rotational deformities. The angular deformity averaged 33.5 degrees (24 degrees -52 degrees ). They were divided into internal rotation (ten cases) or external rotation (one case). One patient required a bilateral rotational osteotomy because of a congenital femoral malrotation combined to bilateral trochlear dysplasia. Rotational correction was, in two patients, simultaneously associated with a closed lengthening osteotomy. Clinical and radiological follow-up averaged 4 years and 9 months (26-104 months). The angular corrections obtained by these rotation osteotomies were calculated by CAT scans.


RESULTS
Ten out of eleven osteotomies allowed a correction within a 4 degrees range in relation to the physiological femoral neck anteversion values (or to the contralateral side in the case of a healthy opposite lower extremity). There was no bone, joint, skin, or soft tissues infection, no pseudoarthrosis and no delayed outgrowth. We observed a transient neurological complication in the area of the pudendal nerve, during a combined rotational-lengthening osteotomy, as well as a bilateral femoral fracture during the bilateral rotational osteotomy. In all patients, consolidation occurred within a 3- to 5-month delay. The subjective results showed that eight out of nine patients (one was lost to follow-up) were satisfied or very satisfied with their operation, their functional recovery and the aesthetic aspects of their scars.


CONCLUSIONS
Closed rotational osteotomies in adults represent a reliable, effective, safe and reproducible procedure for the correction of femoral torsion problems, whether they are post-traumatic or congenital. These results can be obtained only by respecting the indications and by applying a rigorously planned technique, including expertise in centromedullary nailing.


METHODS
Level IV, retrospective therapeutic study.
Gérard
R
R
Orthopaedics, Traumatology and Surgical Reconstructive Department, La Cavale Blanche Hospital, Brest University Hospital Center, boulevard Tanguy-Prigent, 29200 Brest, France. romain.gerard5@orange.fr
Stindel
E
E
Moineau
G
G
Le Nen
D
D
Lefèvre
C
C
D000293:Adolescent; D000328:Adult; D001852:Bone Lengthening / Q000379:methods; D005260:Female; D005269:Femur / Q000002:abnormalities / Q000601:surgery*; D005500:Follow-Up Studies; D006621:Hip Joint / Q000002:abnormalities; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000295:instrumentation* / Q000379:methods*; D012189:Retrospective Studies; D055815:Young Adult