Femoral Head Reduction Osteotomy: Three Guides, One Shared Reference
Reducing the size of the femoral head means cutting the proximal femur into several pieces, then repositioning them so that the remaining articular cartilage forms a more congruent surface.
Each piece moves. Each cut has to land exactly where it was planned.
Dr. Wudbhav Sankar, at the Children's Hospital of Philadelphia, referred a femoral head reduction osteotomy. The plan removed a wedge of bone, translated the lateral fragment, rotated a second fragment, and refixed the greater trochanter.
Four Pieces, Four Different Moves
The procedure starts by detaching the greater trochanter, taking the cartilage into account. The first guide then frees a second fragment and a lateral fragment. The second guide cuts a wedge of bone.
Once the wedge is removed, the lateral fragment is translated onto the step cut left by the wedge. The second fragment is rotated onto the second step cut. Each piece has its own move, and each ends on a surface prepared by a guide.
A Common Reference for Every Step The guide system is built around two parallel K-wires. They are placed with the first guide and stay in the bone for the whole procedure.
The first guide cuts the lateral fragment. It then slides off along the two wires. The second guide slides on the same way and cuts the resection wedge. Each guide returns to the same reference, because it slides over the same wires.
If the first guide is hard to seat, one more K-wire can be introduced. It points at a posterior landmark and can be checked on a lateral fluoroscopic view
Screws Placed Along the Plan
Once the wedge is removed and the fragments are in their final position, a third guide slides over the same two wires. This screw guide pre-drills the paths for the fixation screws across the fragments.
The sequence is planned down to the last detail: one of the parallel wires has to be removed before the last pre-drilling wire goes in.
Closing the Case
The greater trochanter, detached at the start of the procedure, is fixed at the end with the surgeon's preferred technique. We thank Dr. Sankar for his trust and for the precision of his feedback throughout the design process.
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