A corrective osteotomy for post-traumatic malrotation and shortening of the femur

Malrotation following femoral nailing is problematic. We describe a new one-stage technique which utilises three components; a cortico-periosteal sleeve, a "dialled-in"correction of rotation and a peg-shaped osteotomy. Seven patients were treated. The mean correction of malrotation was within 5 degrees of the normal side and the mean correction of length was within 8 mm of the normal side. Clinical union was achieved on average by 6 months (range 4-8 months). The only complication was locking screw breakage in one case. The cortico-periosteal sleeve avoids the need for bone graft, surgery is facilitated by the use of "dialled-in" correction of rotation and a peg to correct length.