1. George V Russell, MD University of Mississippi
Clamshell Osteotomy
George V Russell, MD
University of Mississippi

2. Objectives
Framework
Evolution/rationale
Implementation
Evaluation

3. Axes

4. Angular Deformities

5. Osteotomy Basics

6. Malunion: Deformity IR ER CORONAL SAGITTAL AXIAL MEDIAL LATERAL
TRANSLATION
MEDIAL
LATERAL
ANTERIOR
POSTERIOR
SHORTENED
LENGTHENED
ANGULATION
VARUS
VALGUS
FLEXION
[PROCURVATUM]
EXTENSION
[RECURVATUM] IR ER
So you think about translation and angulation in the coronal, sagittal, and axial planes. And you decide that by the nature of its intramedullary position and its inherent strength through design and material properties, it should be pretty good at controlling deformity in the coronal and sagittal planes. It will be hard for the bone to deform by translation or angulation because you have a good fit between the implant and the bone on each side of the fracture. But the axial plane worries you…and for good reason.

7. MULTIAPICAL DEFORMITIES
MULTILEVEL SOLUTION
Osteotomy per CORA
Other
Muy complicado
Compliments of Jeff Mast, MD

8. Single Cut Solution

9. TA, 43 yo male

10. Your Approach? Closing Wedge Single-Cut Dome/ Crescentic Opening Wedge
Milch

11. Brilliance

12. JH
Desperation

13. IMN for Osteotomies

14. Nail as Reduction Tool

15. Clamshell Osteotomy
Simple planning

16. Clamshell/Conchas

17. Clamshell Osteotomy

18. Clamshell Osteotomy

19. TA, 43 yo male
Preop osteotomy

20. TA
postop osteotomy

21. TA
3 mos post osteotomy

22. TA
1 yr postop
2 yrs postop

23. BT, 53 yo female

24. BT, postop

25. BT, 10 mos

26. Materials and Methods 3 Medical Centers IRB approved
Complex diaphyseal malunions
4 femoral malunions
6 tibial malunions

27. Materials and Methods All deformities post-traumatic
Deformity 18 years (1-50 years)
Avg age 41years (14-71 years)
7 males, 3 females

28. Results
Independent Evaluation
Osteotomies healed by 6 months

29. Radiographic Corrections
Coronal: 2-20 degrees
Sagittal: 0-32 degrees
Axial: 0-25 degrees
Length: 0-5 centimeters
Within 2cm contralateral limb

30. Complications Delayed union—dynamization Broken interlocking bolt
2 wound dehiscences
Local wound care
D&I, closure

31. Clamshell Osteotomy: A New Technique to Correct Complex Diaphyseal Malunions Journal of Bone and Joint Surgery (American). 2009;91:

32. DJ, 40 yo female

33. DJ, postop 4th year resident

34. EG, 38 yo male Preop osteotomy recurvatum posterior translation
varus
shortening
Preop osteotomy

35. EG
Postop osteotomy

36. EG--4 years

37. EM, 60 yo male
Longstanding malunion
HTN
Fall

38. EM
postop

39. EM
6 mos postop

40. EM—1 yr

41. EM--3 years

42. Contraindications Morbid obesity Intramedullary osteomyelitis
Short metaphyseal segment
No intramedullary canal

43. Why I Like Clamshell Planning is simple Nailing is familiar
Nail as reduction device
Technique is transferable

44. Thank You
The Miracle Center