Complex angular and torsional deformities (distal femoral malunions)

Summary

Objective: To describe the surgical technique of complex distal femoral deformity correction with the aid of stereolithography apparatus (SLA) biomodels, stabilized with locking plate fixation.

Methods: Full-size replica epoxy bone bio-models of the affected femurs (4 dogs/5 limbs) were used as templates for surgical planning. A rehearsal procedure was performed on the biomodels aided by a guide wire technique and stabilized with locking plate fixation. Surgery performed in all dogs was guided by the rehearsal procedure. All pre-contoured implants were subsequently used in the definitive surgical procedure with minimal modification.

Results: All dogs had markedly improved, with near normal functional outcomes; all but one had a mild persistent lameness at the final in-hospital follow-up examination (mean: 54.4 weeks; range: 24–113 weeks after surgery). All femurs healed without complications (mean: 34 weeks, median: 12 weeks; range: 8–12 weeks for closing osteotomies, and 26–113 weeks for opening wedge osteotomies). Long-term follow-up examination (mean: 28.6 months; range: 5–42 months) revealed all but one owner to be highly satisfied with the outcome. Complications were observed in two dogs: prolonged tibiotarsal joint decreased flexion that resolved with physical therapy. In one of these dogs, iatrogenic transection of the long digital extensor tendon was repaired, and the other had a peroneal nerve neurapraxia.

Clinical significance: Stereolithography apparatus biomodels and rehearsal surgery simplified the definitive surgical corrections of complex femoral malunions and resulted in good functional outcomes.

Online supplementary material is available for this paper at: http://dx.doi.org/10.3415/VCOT-15-08-0145

Keywords

Angular limb deformity - corrective osteo -tomy - stereolithography - preoperative planning

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