Corrective Intra-Articular Osteotomy Using a 3D-Printed Model and Induced Membrane Technique for AO/OTA C3 Distal Femur Fracture with Articular Malunion and Metaphyseal Nonunion

Figure 5

Illustrated figures of operative procedures. (a) Shows the distal femur seen from the coronal view. Malunited anterolateral fragment was described by a gray dotted line. Osteotomy of the malunited fragments was performed, and anterolateral fragment was temporally fixed to the medial fragment (1). Black arrow indicates the direction of the translation of the fragment at the osteotomy. (b) Shows the distal femur at the axial view. Malunited anterolateral and posterolateral fragments were described by a gray dotted line. Black arrow indicates the direction of the translation of the anterolateral fragment at the osteotomy. Gray arrow indicates the direction of the translation of the posterolateral fragment at the osteotomy. The posterolateral fragment was temporally fixed to the medial fragment (2). Anterolateral and posterolateral fragments were fixed with 6.5 mm cannulated screws (3). (c) Shows the distal femur seen from the coronal view. The anterolateral and medial fragments were fixed with a 6.5 mm cannulated screw (4). Lateral plate and medial plate were used to bridge the metaphyseal lesion and articular lesion (5, 6). Necrotic bone at the metaphyseal part was removed, and bone cement was filled to the bone defect (7). Prox: proximal; Lat: lateral; Vent: ventral; AL: anterolateral fragment; PL: posterolateral fragment; Med: medial fragment.

(a)

(b)

(c)