Correction of complex three-dimensional deformities at the proximal femur using indirect reduction with angle blade plate and patient-specific instruments: a technical note

Lukas Jud,Karl Grob,Lazaros Vlachopoulos

doi:10.1186/s13018-021-02579-z

Abstract

BackgroundCorrective osteotomies for complex proximal femoral deformities can be challenging; wherefore, subsidies in preoperative planning and during surgical procedures are considered helpful. Three-dimensional (3D) planning and patient-specific instruments (PSI) are already established in different orthopedic procedures. This study gives an overview on this technique at the proximal femur and proposes a new indirect reduction technique using an angle blade plate.MethodsUsing computed tomography (CT) data, 3D models are generated serving for the preoperative 3D planning. Different guides are used for registration of the planning to the intraoperative situation and to perform the desired osteotomies with the following reduction task. A new valuable tool to perform the correction is the use of a combined osteotomy and implant-positioning guide, with indirect deformity reduction over an angle blade plate.ResultsAn overview of the advantages of 3D planning and the use of PSI in complex corrective osteotomies at the proximal femur is provided. Furthermore, a new technique with indirect deformity reduction over an angle blade plate is introduced.ConclusionUsing 3D planning and PSI for complex corrective osteotomies at the proximal femur can be a useful tool in understanding the individual deformity and performing the aimed deformity reduction. The indirect reduction over the implant is a simple and valuable tool in achieving the desired correction, and concurrently, surgical exposure can be limited to a subvastus approach.

Highlights

Corrective osteotomies for complex proximal femoral deformities can be challenging; wherefore, subsidies in preoperative planning and during surgical procedures are considered helpful
The preoperative 3D planning can further be enhanced by the combined use with patient-specific instruments (PSI), an approach that has already been established in different orthopedic procedures [13,14,15,16,17,18]
An increasing trend of the implementation of 3D planning and the use of PSI at the proximal femur can be observed. It was the aim of this study to present an overview of this technique at the proximal femur and to introduce a new technique with indirect deformity reduction using PSI in combination with an angle plate to further improve the toolkit in these demanding surgical tasks

Summary

Introduction

Corrective osteotomies for complex proximal femoral deformities can be challenging; wherefore, subsidies in preoperative planning and during surgical procedures are considered helpful. The preoperative 3D planning can further be enhanced by the combined use with patient-specific instruments (PSI), an approach that has already been established in different orthopedic procedures [13,14,15,16,17,18]. An increasing trend of the implementation of 3D planning and the use of PSI at the proximal femur can be observed It was the aim of this study to present an overview of this technique at the proximal femur and to introduce a new technique with indirect deformity reduction using PSI in combination with an angle plate to further improve the toolkit in these demanding surgical tasks

Methods

Discussion

Conclusion