Hello, I'm Al Gedgood. I'm a consultant knee surgeon at the Fowler Kennedy Sport Medicine Clinic, London, Ontario, Canada, and I'm going to be presenting my technique on medial closing wedge distal femoral varus osteotomy. These are my disclosures, none of which are relevant for this particular talk. So we're starting with a left knee, so this is a subvassus approach, so the VMO fascia is incised, and then the vastus medialis muscle is elevated and lifted with a blunt retractor. We can then do this dissection posteriorly along the periosteum, and you can see just that the level of the blood vessels here, this is where we really want to make sure we just subperiosteal dissection to allow us to get another blunt home and retractor placed posteriorly. Pins are then placed both proximally and distally as per the size of the correction that we desire. We just tend to use two pins, and the two pins are then placed with the points coming together at the hinge, and then a biplane osteotomy is planned out initially with cautery, and then completed initially with an oscillating saw, followed by osteotomes, and we should just follow the oscillating saw along each on the inner edge of each of the pins so that it's directed in the correct plane. There's a blunt home and retractor placed posteriorly throughout that's protecting the neurovascular structures, and then the osteotome can be placed again in that same track using fluoroscopic guidance to ensure that you don't go too far, and then the wedge can be removed nice and easily as such, and then the osteotomy is completed again with the osteotomes. It's very useful sometimes to use a kerosene rangeur to remove posterior bone, as that can get hung up and actually stop you from being able to get the correction. It's very important that the anterior cut is completed, so this is the biplane cut on the anterior cortex, and then the lateral cortex is drilled, really it's a controlled osteoclasis to make the correction a little bit more plastic, or the hinge a little bit more plastic, and then that can be closed down, and a locking plate internal fixator is applied, we place some distal fixation first, so we put a couple of locking screws initially to ensure that the plate is fixed in place, and then a proximal bicortical compression screw is placed, and this is placed on the most proximal part of the combi hole, and then on hand compression, this will compress our fracture site, our osteotomy site, and really compress it down nicely and get a very, very stable fixation of primary bone healing, and then the remaining screws can be filled with locking screws, and thank you very much for your attention.

medial closing wedge distal femoral varus osteotomy

fluoroscopic guidance

osteotomy completion process

locking plate internal fixator

distal fixation