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