Femur:

Metode:

Waidelich et al., the center of the femoral head on one transverse slice is connected to the center of an ellipse around the greater trochanter on another transverse slice: alpha angle.

The axis in the distal part of the femur is a tangent to the posterior condyles on a transverse image: beta angle.

Because of the rotation type, femoral anteversion could be calculated by subtraction (external rotation) or addition (internal rotation) of the beta angle from the alpha angle.

Waidelich HA:

The normal extremities of patients older than 18 years showed internal torsion of -20.4 +/- 9 degrees of the femur and external torsion of 33.1 +/- 8 degrees of the tibia. The most important clinical measurement is the intra-individual difference of the torsional angles. Amongst normals this is 4.3 +/- 2.3 degrees in the femur and 6.1 +/- 4.5 degrees in the tibia. Consequently, only angles greater than 9 degrees in the femur and 15 degrees in the tibia should be regarded as abnorm.

Computed tomographic torsion-angle and length measurement of the lower extremity. The methods, normal values and radiation load. Rofo . 1992 Sep;157(3):245-51. doi: 10.1055/s-2008-1033007.

Tibia:

Metode:

Ulm method, the distal tibial axis is drawn between the centers of an ellipse from the surface of the medial malleolus and another ellipse formed by the incisura fibularis.

 

 

 

 

Operationsbeskrivelse:

På indikationen DM 22.2 Patellofemoral malalignment ***
 
I                                                                  Universel anæstesi
foretages efter 5-trinsprocedure                 Extern rotationsosteotomi af femur ***           KNFK 59
  
Lateral adgang bag tractus ileotibialis, hvor distale femur frilægges, det i sættes to steinmann pinde med *** gr vinkling og osteotomien opsaves a.m. Hintervimmer og lille kile udtages og osteotomien roteres ca ***  gr. og fikseres med lagskrue isat anteriort fra og der monteres Loqteq skinne, med 4 låseskruer på hver side af osteotomien og opnåes stabilitet.
 
 
der er givet
Preop. givet 1,5 gram Zinacef iv præoperativt
 
                                                                   Vicryl i 2 lag.
                                                                   Vicryl rapid i hud.
 
Der instilleres                                             40 ml ½% Marcain med adrenalin.
 
Plan:

Mobiliseres med krykkestokke og tilladelse til fuldstøtte. Må fra starten udfører aktiv ekstension mod tyngden. Kan udskrives efter mobilisering.
 
Trådfjernelse egen læge 10-14 dage
Amb. Kontrol efter 4 uger (inkl rtg) og efter 4 md hos undertegnede inkl rtg.

 


 

Advances in modern osteotomies around the knee. Journal of Experimental Orthopaedics volume 6, Article number: 9 (2019)

Nelitz M. Femoral Derotational Osteotomies. Curr Rev Musculoskelet Med. 2018 Jun;11(2):272-279. doi: 10.1007/s12178-018-9483-2. PMID: 29696606; PMCID: PMC5970118.

Derotational Osteotomy of the Distal Femur for the Treatment of Patellofemoral Instability Simultaneously Leads to the Correction of Frontal Alignment: A Laboratory Cadaveric Study

Biplanar supracondylar femoral derotation osteotomy for patellofemoral malalignment: the anterior closed-wedge technique, KSSTA Volume 22, pages 2518–2521, (2014)