PMC9826545_01
Pre-operative (a) and post-operative (b) long leg radiograph of left and right (injured) lower extremities.
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F1
Pre-operative radiographic evaluation of the right lower extremity demonstrated a 5 cm leg length discrepancy, 45  procurvatum, 42  varus, and 35  internal rotation deformity compared to the contralateral, non-injured side (Fig. 1a). Radiographs continued to demonstrated knee arthrosis, but the joint was anatomically aligned, and the osteotomy had healed (Fig. 1b).
Intraoperative fluoroscopic views of a perfect lateral knee (a) and hip (b), identifying 12  anteversion.
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F2
Once the patient consented for the procedure, fluoroscopy was used to check a perfect lateral of the non-injured contralateral knee and hip, which established a baseline of 12  of anteversion (Fig. 2a, 2b).
Intraoperative fluoroscopic view of the osteotomy sites with burr used to help create the canal.
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F3
A drill bit and osteotome were used to perform the three osteotomies (Fig. 3).
Intraoperative fluoroscopic anterior-posterior (a) and lateral (b) hip, identifying the medial tip of the greater trochanter.
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F4
Afterward, anterior-posterior and lateral views of the hip were obtained to identify the medial tip of the greater trochanter proximally (Fig. 4a, 4b).
Intraoperative fluoroscopic views of a ball-tipped guide wire (a) and opening tibial reamer (b) in osteotomized pieces.
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F5
Then, an opening reamer for the tibial nail was used to enlarge the canal to allow for insertion of the ball tip guide wire (Fig. 5a, 5b).
Immediate post-operative radiographic views status post-re-alignment osteotomies, lengthening, and nail insertion.
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F6
Screws were then placed in a center-center position in the head (Fig. 6a). Once the joint was in anatomical position, two distal interlocking screws were inserted, and the osteotomy sites were packed with biologic bone graft for healing (Fig. 6b).
Nine-month post-operative right femur radiographs showing complete union with callus formation at osteotomy sites.
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F7
Radiographs at 9 months postoperatively depicted complete bone union with callus formation, and the femur measured 1.2 cm shorter on the operative side (Fig. 7a, 7b).
One-year post-operative radiographs showing complete bone union and anatomic alignment of right femur.
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F8
Radiographs of the femur demonstrated anatomical alignment (Fig. 8a, 8b).