Derotational open wedge distal femoral osteotomy

#surgicalpearls

measure axis femoral head to ankle

correct to medial tibial spine

measure angle of correction/wedge needed

confirm w/alignment rod

do #Mosaicplasty #cartilagerestoration first

2 breakable parallel oblique (proximal to distal) pins distal femur 

+/- 2 additional pins proximal and distal segment to measure rotation correction

Oscillating saw cortex, anterior + posterior (protect w/ Hohman)

Care not to breach medial cortex - leave 1 cm

Use variable size osteotomes

Leave wedges in then apply matching plate w/ spacer

External rotate distal segment to get trochlea underneath the patella i.e. correct excessive #femoralanteversion (internal rotation of femur)

Apply locking plate 

+/- wedge allograft or iliac crest autograft or bone chips