Tomofix distal femoral plate

Diagnostic arthroscopy was performed first to evaluate the cartilage, patellar tracking, and the integrity of the medial retinaculum. In cases of a high lateralization tendency following D-DFO, an additional reconstruction of the MPFL using the ipsilateral gracilis tendon was performed.
A biplanar supracondylar torsional osteotomy of the femur was performed via a standardized lateral subvastus approach. A detailed description of the authors’ preferred operative technique was previously described [8 (link)]. The degree of torsional correction was controlled via two bicortically placed Kirschner wires or Steinman nails proximal and distal to the osteotomy from an axial view. For fixation of the osteotomy, an internal plate fixator system with locking screws was used (Tomofix distal femoral plate, dePuy Synthes, Umkirch, Germany). The aim of the coronal correction was to achieve neutral alignment.

The target postoperative FAA value was 10°. DDFO was performed with a 10-cm incision on the lateral thigh along the longitude axis of the distal femur. The distal femoral shaft was exposed through the intermuscular space after the separation of the subcutaneous tissue and incision of the borders of the biceps femoris and vastus lateralis. The supracondylar osteotomy line was marked with two Kirschner wires, which were set parallel to the tibiofemoral joint line. Then the Kirschner wires were inserted into the osteotomy line to determine the rotational angle between the two wires based on the preoperative CT measurements, which was verified by intraoperative fluoroscopy. After osteotomy with an oscillating saw according to the direction of the guide pin, the distal femur was externally rotated to a predetermined angle to adjust the rotational alignment and correct increased FAA. After temporarily fixing the femoral shaft, fluoroscopy was used to check the reduction of the femoral shaft. Finally, the distal femur was fixed with one lateral femur plate (Figure 5). The femur was fixed using a Tomofix distal femoral plate (DePuy Synthes, Umkirch, Germany) with 9 screws after osteotomy (Figure 6). Stop bleeding and suture the wound layer by layer.