Clamshell Osteotomy

George V Russell, MDUniversity of Mississippi

Objectives• Framework• Evolution/rationale• Implementation• Evaluation

Axes

Angular Deformities

Osteotomy Basics

Malunion:Deformity

CORONAL SAGITTAL AXIAL

TRANSLATION MEDIALLATERAL

ANTERIORPOSTERIOR

SHORTENEDLENGTHENED

ANGULATION VARUSVALGUS

FLEXION[PROCURVATUM]

EXTENSION[RECURVATUM]

IRER

MULTIAPICAL DEFORMITIESMULTILEVEL SOLUTION• Osteotomy per CORA• Other

Single Cut Solution

TA, 43 yo male

Your Approach?

Milch

Single-Cut

Dome/Crescentic

Opening Wedge

Closing Wedge

Brilliance

JH

IMN for Osteotomies

Nail as Reduction Tool

Clamshell Osteotomy

Simple planning

Clamshell/Conchas

Clamshell Osteotomy

Clamshell Osteotomy

TA, 43 yo male

Preop osteotomy

TA

postop osteotomy

TA

3 mos post osteotomy

TA

1 yr postop 2 yrs postop

BT, 53 yo female

BT, postop

BT, 10 mos

Materials and Methods• 3 Medical Centers• IRB approved• Complex diaphyseal malunions

– 4 femoral malunions– 6 tibial malunions

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

Results• Independent Evaluation• Osteotomies healed by 6 months

Radiographic Corrections• Coronal: 2-20 degrees• Sagittal: 0-32 degrees• Axial: 0-25 degrees• Length: 0-5 centimeters

– Within 2cm contralateral limb

Complications• Delayed union—dynamization• Broken interlocking bolt• 2 wound dehiscences

– Local wound care– D&I, closure

DJ, 40 yo female

DJ, postop4th year resident

EG, 38 yo male

Preop osteotomy

posterior translation

varus

translation

recurvatum

shortening

EG

Postop osteotomy

EG--4 years

EM, 60 yo male

Longstanding malunion

Fall

HTN

EM

postop

EM

6 mos postop

EM—1 yr

EM--3 years

Contraindications

• Morbid obesity• Intramedullary osteomyelitis• Short metaphyseal segment• No intramedullary canal

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

Thank You

The Miracle Center