Strategies in Trauma and Limb Reconstruction

Register      Login

VOLUME 13 , ISSUE 2 ( August, 2018 ) > List of Articles

TECHNICAL REPORT

The Resolution Axis Method (RAM) for lengthening of the femur with or without associated frontal plane deformity (a new method)

Sherif Galal

Keywords : Deformity, Femur, Lengthening, Planning

Citation Information : Galal S. The Resolution Axis Method (RAM) for lengthening of the femur with or without associated frontal plane deformity (a new method). 2018; 13 (2):109-118.

DOI: 10.1007/s11751-018-0312-3

License: CC BY-NC-SA 4.0

Published Online: 31-08-2018

Copyright Statement:  Copyright © 2018; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction Femoral lengthening with or along intramedullary (IM) nails will occur along the axis of the nail coincident with the anatomical axis of the bone. In the femur particularly, such lengthening often creates lateral mechanical axis deviation as the knee is driven medially. In cases where shortening is associated with frontal plane deformity the surgeon needs to correct the deformity intra-operatively, however, subsequent lengthening along the anatomical axis will create deformity. Thus, planning for lengthening of the femur with or along IM nails, whether shortening is associated with frontal plane deformity or not, requires a completely different planning strategy. The author questioned if a resolution anatomical axis can be identified and used for planning when lengthening the femur along or with IM nails while still applying the same classic CORA deformity analysis method. Methods In a prospective study, the author included eight patients who needed femoral lengthening, five with associated frontal plane deformity and three without. The author identified a method to determine the trajectory of the nail in the lower femoral segment. It was done by calculating the angle enclosed between this resolution anatomical axis and the mechanical axis, also known as the anatomical-mechanical angle. Results This new method has proven to be effective in achieving normal alignment after lengthening is completed. Conclusion The Resolution Axis Method is a new and alternative method providing a solution for planning when lengthening the femur along the anatomical axis using an IM nail, whether a deformity is present or not.


PDF Share
  1. Baumgart R (2009) The reverse planning method for lengthening of the lower limb using a straight intramedullary nail with or without deformity correction. A new method. Oper Orthop Traumatol 21(2):221-233
  2. Burghardt RD, Paley D, Specht SC, Herzenberg JE (2012) The effect on mechanical axis deviation of femoral lengthening with an intramedullary telescopic nail. J Bone Joint Surg Br. 94:1241-1245
  3. Paley D (2002) Radiographic assessment of lower limb deformities, frontal plane mechanical and anatomical axis planning. In: Paley D (ed) Principles of deformity correction. Springer, Berlin- Heidelberg, pp 31-98
  4. Paley D, Herzenberg JE, Paremain G, Bhave A (1997) Femoral lengthening over an intramedullary nail. A matched-case comparison with Ilizarov femoral lengthening. J Bone Joint Surg Am 79(10):1464-1480
  5. Paley D, Herzenberg JE, Bor N (1997) Fixator-assisted nailing of femoral and tibial deformities. Techn Orthop 12(4):231-295
  6. Stedtfeld HW, Mittlmeier T, Landgraf P, Ewert A (2004) The logic and clinical applications of blocking screws. J Bone Joint Surg Am 86(suppl 2):17-25
  7. Whitaker AT, Gesheff MG, Jauregui JJ, Herzenberg JH (2016) Comparison of PACS and Bone Ninja mobile application for assessment of lower extremity limb length discrepancy and alignment. J Child Orthop 10(5):439-443
  8. Wagner P, Standard SC, Herzenberg JE (2017) Evaluation of a mobile application for multiplier method growth and epiphysiodesis timing predictions. J Pediatr Orthop 37:e188-e191
  9. Siddiqui NA, Lamm BM (2014) Digital planning for foot and ankle deformity correction: evans osteotomy. J Foot Ankle Surg 53(6):700-705
  10. Kucukkaya M, Karakoyun O, Kuzgun U (2013) Lengthening over a retrograde nail using 3 Schanz pins. J Orthop Trauma 27:13-17
  11. Ostrum R, Agarwal A, Lakatos R et al (2000) Prospective comparison of retrograde and antegrade femoral intramedullary nailing. J Orthop Trauma 14:496-501
  12. Daglar B, Gungor E, Delialioglu OM et al (2009) Comparison of knee function after antegrade and retrograde intramedullary nailing for diaphyseal femoral fractures: results of isokinetic evaluation. J Orthop Trauma 23:640-644
  13. Poyanli O, Unay K, Akan K et al (2010) No evidence of infection after retrograde nailing of supracondylar femur fracture in gunshot wounds. J Trauma 68:970-974
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.