Clamshell Osteotomy and Retrograde PRECICE Lengthening

Clamshell osteotomy is a well-described diaphyseal osteotomy to address multi-plane deformities. One potential limitation of the osteotomy is acute lengthening, as this may result in excessive separation of intercalary osteotomy fragments, potentially resulting in delayed or failed healing. This technique is commonly stabilized with an intramedullary nail. Magnetic lengthening nails have found multiple uses in deformity correction, including limb lengthening. In this clinical case, a patient with end-stage knee arthritis required femoral deformity correction and lengthening prior to total knee arthroplasty. The patient was treated with clamshell osteotomy and distraction osteogenesis to restore length and alignment to the limb. Conversion to primary total knee arthroplasty was then performed with prophylactic stabilization of the ipsilateral femoral neck and shaft with a standard medullary trauma nail.