Windswept Rotational Deformity with Fixator Assisted Plating

2022-06-13 07:37:24 By : Ms. Wanda Chen

This is a 54-year-old female who presented to our clinic with decreased ability to ambulate, chronic pain and a limb-length discrepancy. The patient was in a high-speed motor vehicle accident at age 17. She suffered proximal femur and pelvic fractures that subsequently required bilateral total hip replacement one year post injury. Since her index hip replacements she has had 11 revision surgeries. She has difficulty ambulating and walks like a crab. He lower extremities point in a direction that is about 45 degrees rotated from the direction that her pelvis faces.

The femoral valgus and rotational deformities are approached first by staged bilateral distal femur osteotomies. Locking plates are utilized, and augmented with cables where screw fixation is comprised because of the long femoral stem. Once the coronal and axial planes are corrected a new 51’’ hip to ankle x-ray is used to assess limb length discrepancy. Tibial lengthening and residual axial malalignment is then performed.

1. Pulisetti TD, Onwochei MO, Ebraheim NA, Humphries C, Coombs RJ. Mathematical precision in rotational corrective osteotomy of the femur. J Orthop Trauma. 1998;12:360-362.

2. Radler C, Kranzl A, Manner HM, Hoglinger M, Ganger R, Grill F. Torsional profile versus gait analysis: consistency between the anatomic torsion and the resulting gait pattern in patients with rotational malalignment of the lower extremity. Gait Posture. 2010;32:405-410.

3. Rozbruch SR. Fixator assisted plating of limb deformities. Operative Techniques in Orthopaedics. 2011;21:174-179.

4. Rozbruch SR, Kleinman D, Fragomen AT, Ilizarov S. Limb lengthening and then insertion of an intramedullary nail: a case-matched comparison. Clin Orthop Relat Res. 2008;466:2923-2932.

5. Seah KT, Shafi R, Fragomen AT, Rozbruch SR. Distal femoral osteotomy: is internal fixation better than external? Clin Orthop Relat Res. 2011;469:2003-2011.

Fellow, Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery