Femoral Derotational Osteotomy Using a Modified Intramedullary Nail Technique

When persistent rotation of the femur remains into adolescence, it can cause functional limitations such as fatigue, anterior knee pain, and frequent tripping. In these cases, derotation of the femur via osteotomy is often performed. We report preliminary results of bilateral derotational osteotomy for excessive femoral anteversion or retroversion using the modified intramedullary nail technique. A retrospective review of 8 patients was performed. Patients were excluded if additional procedures were performed or if the femoral osteotomy included any deformity correction other than rotation. Each patient had simultaneous bilateral femoral osteotomies for a total of 16 limb segments to review. The average age was 12 years, with 4 boys and 4 girls in the group. Seven patients had a preoperative diagnosis of femoral anteversion, and 1 had femoral retroversion. Average amount of derotation performed averaged 30 degrees. Average length of follow-up was 10 months (range, 9 to 12 mo). Average surgical time to complete the bilateral ostetomies was 139 minutes with an average total blood loss of 106 mL. The patients returned to full weight bearing with assistance at 13.75±1.39 days, without assistance at 37.12±5.69 days, and demonstrated full radiographic healing of the femur at 76.13±20.92 days. A modified intramedullary nail technique provides a biologically sound method for rapid healing of the femoral osteotomy site by providing autograft directly to a stable osteotomy site with minimal disruption of the surrounding soft tissue envelope, resulting in faster healing and a quicker return to full, unassisted weight bearing.