Rotational femoral osteotomies using an endomedullary saw

SummaryIntroductionThe 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.HypothesisFemoral endomedullary osteotomy is a safe procedure to correct malrotations.Patients and methodsEleven 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° (24°–52°). 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.ResultsTen out of eleven osteotomies allowed a correction within a 4° 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.DiscussionClosed 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.Level of evidenceLevel IV, retrospective therapeutic study.