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Nailing - Valgus Deformity Distal Femur

The picture on the left side shows an example of bilateral valgus deformity(knock knees) at the distal femur i.e. reduced angle at the outer side of the thigh bone close to the knee. Here the growth if the patient is complete and there is no limb length discrepancy.

The picture on the right side was taken during the surgery. The metallic contraption is used as a guide for cutting the bone.

The incision shown is about 1.25 cm long. The bone is cut using this incision and with minimal soft tissue stripping, which helps in better bone healing and better results for the patient.
Percutaneous Osteotomy
Percutaneous osteotomy is performed using minimally invasive technique through a small incision, just enough to permit the osteotome with minimal soft tissue stripping.

The pictures here show the xrays done during surgery. Drill holes are made using the jig. The entry path for the nail in the distal part of the bone is marked using k-wire and cannulated drill bit. Another instrument like osteotome is used to mark the correct angle.

The holes are then connected and osteotomy is completed using the osteotome.
Translation, Fixation
These are x-ray pictures taken during surgery. The left one shows the path of entry of the guide wire as seen from the side.

The picture in the center shows how the bone is translated(shifted on the long axis) at the osteotomy site. This is done in accordance with osteotomy rule 2(i.e when the osteotomy is away from the CORA-center of rotation axis.)

The picture on the right shows the final picture after the insertion of the intra-medullary nail in the corrected position with locking bolt holding the nail to the bone.
These are pictures taken about 10 weeks post surgery. She is able to bear full weight on the leg. The clinical appearance of the operated left side as seen in the picture on the left. The un-operated leg on the right side can be compared with the left side.

The pictures in the center and right show the x-rays with good amount of callus formation and strong healing. The osteotomy line is still seen, which disappears in another 6-8 weeks.
Final Result
The final result after correction of both sides with excellent functional results. She has full flexion at the knee, able to sit cross-legged and able to perform all activities comfortably.