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Malunions: Principles of Evaluation & Treatment Clifford B Jones, MD Orthopaedic Associates of Michigan Clinical Professor, MSU/CHM Grand Rapids, MI May.

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Presentation on theme: "Malunions: Principles of Evaluation & Treatment Clifford B Jones, MD Orthopaedic Associates of Michigan Clinical Professor, MSU/CHM Grand Rapids, MI May."— Presentation transcript:

1 Malunions: Principles of Evaluation & Treatment Clifford B Jones, MD Orthopaedic Associates of Michigan Clinical Professor, MSU/CHM Grand Rapids, MI May 2011

2 What is a malunion? Bone healed in a nonanatomic position –Affect function? –Likely to affect function? –Consequences with or without treatment

3 What is a malunion? Limits of deformity vary by bone and plane –Somewhat arbitrary –Merchant and Dietz, JBJS 1989 No long term effects on knee or ankle function at 29 years with deformity >10 degrees after tibia fx

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6 Planes of deformity Articular (splits and depressions!) Length Angulation Rotation Combined

7 Evaluation Length –Measure –Blocks –Scanogram –CT scanogram

8 Evaluation Angulation –AP/lat X-rays –Comparison views –Long leg films Standing

9 Evaluation Rotation –Exam (rotational profile) –CT

10 Evaluation Rotation –Exam (rotational profile) –CT

11 Correction Planning

12 Correction: Closing wedge Single site to heal Biomechanically sound Soft tissue friendly Corrects angulation May shorten No graft required

13 Correction: Closing wedge

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15 Cut Insert Compress Finalize

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17 Correction: Opening Wedge Two sites to heal Need graft Tension soft tissue –Pre op plan soft tissue integrity Allows lengthening

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20 Oblique osteotomy Single site to heal Large surface to heal Compression at site Can lengthen No graft Creates some rotation

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22 Oblique osteotomy Define plane of deformity

23 Oblique osteotomy Define plane of deformity

24 Oblique osteotomy Define plane of deformity Oblique cut

25 Oblique osteotomy Define plane of deformity Oblique cut Rotate through cut

26 Oblique osteotomy Define plane of deformity Oblique cut Rotate through cut

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31 16 F, 2 years s/p Flex IMN for Proximal Third Femoral Fracture Short, Varus, Apex Anterior, Painful Lateral Thigh Deformity

32 PRE OP PLAN

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35 54 M, 13 years s/p Open tibial Fx & Osteomyelitis Now, complaining of knee and tibial pain with activities

36 Single Cut Osteotomy Osteotomy Fibula Lag screw compression Medial Plate Stabilization

37 Multiplanar osteotomies

38 Closed Femur IMN x 3 Valgus Short 3.5 cm

39 Planning & Reduction

40 1 year post op

41 IMN transverse osteotomy

42 IMN, ORIF, Multiple Intramedullary Osteotomies Short 2.5 cm Painful Lateral Thigh Deformity IR Rotation Deformity 45° 2 Prior Failed ACL Recon

43 Multiple Intramedullary Osteotomies Proximal Osteotomy Regenerate Recanalization Mid & Mid Osteotomy Distal Osteotomy & Translation

44 ER Rotate Translate

45 “Clamshell” osteotomy: G. Russell, MD

46 “Clamshell” Osteotomy: G. Russell, MD

47 “Clamshell” osteotomy: G. Russell, MD

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51 Ilizarov Method

52 Combination Method Osteotomy, Derotation, & Lengthening 45 M, Fall from ladder 18 mo prior Short Gamma IMN for Reverse Oblique Fx Pattern Began WBAT at 6 wks Complains of LLD (3.5 cm) and Inability to walk with his foot straight (45° ER Deformity)

53 Remove IMN & Ream Canal Intramedullary Osteotomy Derotate Leg – 45 Internal Rotation

54 Insert IMN – No Dist IL Apply Uniplanar & Unicortical External Fixator Begin Distraction Osteogenesis

55 When desired length obtained: Return to OR Insert Distal IL Screws Remove External Fixator

56 Mid & Ending Distraction

57 Final Result

58 End Result

59 Complex problems Identify the problem Determine the consequences (with or without intervention) Plan the correction Execute the plan Lifelong learning

60 Thank You OTA about Questions/Comments If you would like to volunteer as an author for the Resident Slide Project or recommend updates to any of the following slides, please send an to Return to General/Principles Index


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