View
266
Download
3
Category
Preview:
Citation preview
Clamshell Osteotomy
George V Russell, MDUniversity of Mississippi
Objectives• Framework• Evolution/rationale• Implementation• Evaluation
Axes
Angular Deformities
Osteotomy Basics
Malunion:Deformity
CORONAL SAGITTAL AXIAL
TRANSLATION MEDIALLATERAL
ANTERIORPOSTERIOR
SHORTENEDLENGTHENED
ANGULATION VARUSVALGUS
FLEXION[PROCURVATUM]
EXTENSION[RECURVATUM]
IRER
MULTIAPICAL DEFORMITIESMULTILEVEL SOLUTION• Osteotomy per CORA• Other
Single Cut Solution
TA, 43 yo male
Your Approach?
Milch
Single-Cut
Dome/Crescentic
Opening Wedge
Closing Wedge
Brilliance
JH
IMN for Osteotomies
Nail as Reduction Tool
Clamshell Osteotomy
Simple planning
Clamshell/Conchas
Clamshell Osteotomy
Clamshell Osteotomy
TA, 43 yo male
Preop osteotomy
TA
postop osteotomy
TA
3 mos post osteotomy
TA
1 yr postop 2 yrs postop
BT, 53 yo female
BT, postop
BT, 10 mos
Materials and Methods• 3 Medical Centers• IRB approved• Complex diaphyseal malunions
– 4 femoral malunions– 6 tibial malunions
Materials and Methods• All deformities post-traumatic• Deformity 18 years (1-50 years)• Avg age 41years (14-71 years)• 7 males, 3 females
Results• Independent Evaluation• Osteotomies healed by 6 months
Radiographic Corrections• Coronal: 2-20 degrees• Sagittal: 0-32 degrees• Axial: 0-25 degrees• Length: 0-5 centimeters
– Within 2cm contralateral limb
Complications• Delayed union—dynamization• Broken interlocking bolt• 2 wound dehiscences
– Local wound care– D&I, closure
DJ, 40 yo female
DJ, postop4th year resident
EG, 38 yo male
Preop osteotomy
posterior translation
varus
translation
recurvatum
shortening
EG
Postop osteotomy
EG--4 years
EM, 60 yo male
Longstanding malunion
Fall
HTN
EM
postop
EM
6 mos postop
EM—1 yr
EM--3 years
Contraindications
• Morbid obesity• Intramedullary osteomyelitis• Short metaphyseal segment• No intramedullary canal
Why I Like Clamshell• Planning is simple• Nailing is familiar• Nail as reduction device• Technique is transferable
Thank You
The Miracle Center
Recommended