External fixation in orthopedics.
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External Fixators↗
Biomedical subjects
Joseph J Gugenheim
Publications and source records attributed to Joseph J Gugenheim.
Ilizarov correction of malrotated femoral shaft fracture initially treated with an intramedullary nail: a case report.
Ideally, acquired femoral malrotation as a complication of intramedullary nailing of a femoral shaft fracture should be identified and corrected early in the course of treatment. In this report, we present a previously undescribed precise surgical technique for acutely correcting an acquired femoral malrotation deformity 20 days after fixation of a femoral shaft fracture with a statically locked intramedullary nail. An llizarov external fixator was used intraoperatively to correct a 27 degree femoral malrotation deformity in a 19-year-old man.
Adult↗
Bone realignment with use of temporary external fixation for distal femoral valgus and varus deformities.
BACKGROUND: Correction of a distal femoral deformity may prevent or delay the onset of osteoarthritis or mitigate its effects. Accurate correction of deformity without production of a secondary deformity depends on precise localization and quantification of the deformity. We report a technique to correct distal femoral deformities in the coronal plane. METHODS: Fourteen femora in thirteen skeletally mature patients with a distal femoral deformity underwent operative reconstruction. The preoperative deviation of the mechanical axis ranged from 90 mm laterally (genu valgus) to 120 mm medially (genu varus). The mechanical lateral distal femoral angle was abnormal in all fourteen knees. The technique consisted of application of an external fixator, performance of a percutaneous distal femoral dome osteotomy, correction of the deformity, and locking of the external fixator. A statically locked retrograde intramedullary nail was inserted following reaming, and the external fixator was removed. The mean duration of follow-up was thirty-three months (range, six to forty-seven months). RESULTS: The mean time until healing was thirteen weeks (range, six to thirty-nine weeks). Nine of the thirteen patients reported an improvement in walking, and none needed an assistive device. All nine patients with preoperative knee pain were free of tibiofemoral pain at the most recent follow-up evaluation. The mechanical lateral distal femoral angle was within the normal range in twelve of the fourteen knees. The mechanical axis was within the normal range in ten lower extremities. In three of the four remaining limbs, the residual abnormal deviation of the mechanical axis was due to a residual tibial deformity. CONCLUSIONS: Percutaneous dome osteotomy combined with temporary external fixation and insertion of an intramedullary nail can correct distal valgus and varus femoral deformities. We attributed the early mobilization of patients and the rapid bone-healing to the limited soft-tissue dissection, the low-energy corticotomy, and the use of intramedullary fixation in our surgical technique.
Activities of Daily Living↗
The effects of femoral shaft malrotation on lower extremity anatomy.
OBJECTIVE: To determine how axial rotation around the anatomic axis of the femur, as would occur with malrotation of a femoral fracture, affects frontal and sagittal plane alignment and knee joint orientation. DESIGN: Computer-generated models of the lower extremity were constructed using standardized dimensions. To simulate a malrotated fracture, these models were rotated in the shaft around the anatomic axis in 15 degrees increments from 60 degrees internal to 60 degrees external rotation. Rotation was performed at the proximal fourth, mid-shaft, and distal fourth. MAIN OUTCOME MEASUREMENTS: At each rotational position, the mechanical axis deviation in millimeters and the changes in mechanical lateral distal femoral angle in degrees were measured to quantify frontal plane malalignment and malorientation, respectively. The mechanical axis deviation in millimeters in the sagittal plane was also measured at each rotatory position. RESULTS: Femoral shaft malrotation greater than 30 degrees internal rotation of a subtrochanteric fracture or more than 45 degrees of a midshaft fracture or external rotation of 30 degrees or greater of a supracondylar fracture resulted in frontal plane malalignment. External rotation of a supracondylar fracture of 45 degrees or more results in knee joint malorientation. Any external rotation at all 3 fracture levels caused posterior displacement of the weight-bearing axis in the sagittal plane. CONCLUSIONS: Malrotation of a femoral shaft fracture is not just a cosmetic problem. Internal and external rotation causes malalignment and malorientation in the frontal plane, depending on the level of the fracture and the magnitude of malrotation. External rotation of any degree at the proximal fourth, mid-shaft, and distal fourth causes a posterior shift of the weight-bearing axis in the sagittal plane.
Biomechanical Phenomena↗