Name of the Procedure:

Osteotomy, multiple, with realignment on intramedullary rod, femoral shaft (e.g., Sofield type procedure)

Summary

An osteotomy is a surgical procedure where bones are cut and realigned. In this specific procedure, multiple osteotomies (bone cuts) are made on the femoral shaft (thigh bone) and are then realigned using an intramedullary rod (a metal rod inside the bone). This is often referred to as a Sofield type procedure.

Purpose

The procedure is performed to correct deformities, misalignments, or fractures in the femoral shaft. The main goal is to straighten the bone and stabilize it, improving function and alleviating pain.

Indications

• Severe bone deformities due to osteogenesis imperfecta (brittle bone disease)
• Malunion or nonunion of femoral fractures
• Severe femoral bowing or angular deformities
• Patients with recurrent fractures or chronic bone instability

Preparation

• Patients are usually required to fast for at least 8 hours before the procedure.
• Preoperative blood tests, imaging (X-rays or CT scans), and a physical examination may be required.
• Medication adjustments, such as pausing anticoagulants, may be necessary.

Procedure Description

1. Under general anesthesia, the surgeon makes an incision over the femur.
2. Multiple osteotomies are performed along the femoral shaft.
3. The femur is realigned to the desired anatomical position.
4. An intramedullary rod is inserted into the femoral canal to stabilize the bone.
5. The surgeon may use screws or other hardware to secure the rod and bone segments.
6. The incision is closed with sutures or staples, and a sterile dressing is applied.

Duration

The procedure typically takes 2 to 4 hours, depending on the complexity and number of osteotomies required.

Setting

The osteotomy procedure is performed in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection at the incision site
• Blood clots
• Nerve or blood vessel damage
• Nonunion or delayed healing of the bone
• Hardware failure or migration
• Postoperative pain and swelling

Benefits

• Improved bone alignment and stability
• Reduced pain and improved function
• Increased ability to bear weight and perform daily activities
• Decreased risk of future fractures in the affected femur

Recovery

• Patients may stay in the hospital for a few days post-surgery.
• Pain management with medications.
• Physical therapy typically starts soon after surgery to aid in mobility and strengthen muscles.
• Weight-bearing restrictions may be in place for several weeks to months.
• Follow-up appointments for X-rays and clinical evaluation are necessary.

Alternatives

• Orthopedic bracing or external supports
• Physiotherapy and rehabilitation
• Non-surgical correction techniques (depends on the type and severity of deformity)
• Pros of alternatives: less invasive, fewer risks.
• Cons of alternatives: may not provide as effective or permanent solutions for severe deformities.

Patient Experience

• During the procedure, the patient will be under general anesthesia and will not feel any pain.
• Postoperatively, patients may experience discomfort, swelling, and pain, which can be managed with medications.
• Physical therapy and gradual resumption of activities will be necessary.
• Full recovery may take several months, during which mobility aids may be needed.