Correction of a complex multiplanar deformity of the right femur

This is a case we chose to share because it represents the kind of challenge that requires both surgical finesse and engineering precision.

The patient presented with a complex multiplanar deformity of the right femur, involving both proximal and distal segments. The deformity included a marked procurvatum, severe angulation in the frontal plane, and misalignment that would make intramedullary fixation the most challenging aspect.

The strategy involved a double osteotomy:

– A proximal femoral closing wedge (33° frontal and 15° sagittal)

– A distal medial wedge osteotomy (10° frontal and 5° sagittal) to balance the correction distally and avoid overloading the knee joint. 

The proximal correction alone was not enough to ensure proper alignment for the custom-made intramedullary nail.

The team needed to translate the proximal fragment medially, fine-tune the neck-shaft angle, and correct the sagittal axis to allow smooth nail insertion and optimal cortical contact.

Additional aligner guides were designed to maintain the planned correction during the nail insertion phase. These guides relied on carefully placed alignment K-wires and extra fixation Kwires in the cortical bone to allow the intramedullary nail to pass smoothly.

This case went through several iterations, with the surgical plan adjusted multiple times based on the surgeon’s feedback.

Corrections included modifying the sagittal curve, lateralizing the nail entry point, adjusting the position of the screws, and ultimately reassessing the LDFA to avoid creating a secondary valgus deformity.

What made this case particularly demanding was not the magnitude of a single deformity, but the need to combine multiple moderate corrections across two anatomical levels — each influencing the outcome of the other — while ensuring compatibility with a custom implant.

It’s a clear example of how close collaboration between surgeon and planning team can help bring complex scenarios toward a controlled and safe surgical solution.

Thank you Dr Gabriel T. Mindler for your valuable input throughout the planning and for the excellent surgical execution of this complex case.

#3dcud #complexmultiplanardeformity #supersurgeon