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Briard Jl. How To Correct Extra Articular Deformity. Slide 27 40

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Briard Jl. How To Correct Extra Articular Deformity. Slide 27 40

  1. 1. <ul><li>lateral release: but bad structures for release which may be weak or loose and lead to lateral instability in flexion </li></ul><ul><li>resect more medial plateau </li></ul><ul><li>DANGER of subsequent medial instability! </li></ul>
  2. 2. <ul><li>in flexion: </li></ul><ul><li>femoral rotation unchanged </li></ul><ul><li>patella : OK </li></ul><ul><li>but lateral structures are elongated and weak and there is a danger of overstretching and of rotating the femoral implant to obtain stability. </li></ul>
  3. 3. <ul><li>So, with such a knee: </li></ul><ul><li>in flexion: use the transepicondylar line as a guide to be parallel with the AP cuts </li></ul><ul><li>use a constrained design for small deformity </li></ul><ul><li>Or, you may: </li></ul><ul><li>Want to keep the lateral structures strong </li></ul><ul><li>use lateral condyle osteotomy ???? </li></ul><ul><li>(not an excellent indication) </li></ul>
  4. 4. <ul><li>But, if the deformity is more important > 8-10° </li></ul><ul><li>Concomitant tibial </li></ul><ul><li>metaphyseal </li></ul><ul><li>osteotomy </li></ul><ul><li>Medial closing wedge </li></ul><ul><li>Lateral opening wedge </li></ul>Opening wedge
  5. 5. <ul><li>Tibia valgum </li></ul>192° Watch out !
  6. 6. <ul><li>180° </li></ul>and then …Closing wedge IA surgery
  7. 7. 4th MESSAGE <ul><li>Femoral deformities are more difficult than tibial deformities </li></ul><ul><li>Because their correction influences both extension & flexion gap </li></ul><ul><li>Femur varum ++++ </li></ul><ul><li>Valgum deformities are difficult due to release technique and risk of instability </li></ul>
  8. 8. 60 y old Femur varum + malunion in IR 163°
  9. 9. IA surgery + femoral osteotomy
  10. 10. Gosse 162 182 scan: +15 –15° 162° Malunion Supracondylar Fx 67 Y
  11. 11. Retroversion: 14° Anteversion: 15° 29° Internal Rotation
  12. 12. 182°
  13. 14. If you want to achieve correct surgery:

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