Complex Femoral Deformity: Acute Correction and IM Nail Fixation

The use of circular external fixator for gradual correction of complex limb deformities is a relatively safe method with great accuracy depending on the surgeon’s experience. Since the external fixator is cumbersome for the patient, a more convenient fixation method can be used in carefully selected cases. Provided that the resultant leg length discrepancy after treatment is less than one inch and is acceptable to the patient, then, acute correction of diaphyseal deformities and fixation with a statically locked intramedullary nail can be successful yielding a gratifying result to both the patient and the surgeon. The magnitude of the deformity and direction of correction should be considered to avoid sudden stretch of the neurovascular bundle. Another consideration is the soft tissue condition and history of deep infection which would preclude the use of internal fixation. Complex diaphyseal deformityComplex diaphyseal deformity of a long bone may need more than one osteotomy to restore the normal mechanical axis. Resolution of the deformities into one CORA (center of rotation of angulation) to achieve correction through one osteotomy is an attractive idea having the advantage of longer bone segments for stable fixation. Careful preoperative planning is mandatory to determine the osteotomy level and the nail-insertion point.