Successful Correction of Lower-Limb Malunions Using Intramedullary Nailing and Chipping Osteotomy: A Case Series.

Abstract

BACKGROUND Lower-limb fracture malunion can result in angular deformity that requires surgical correction. Chipping corrective osteotomy (CCO) is a novel method that involves a chipping technique at the center of rotation of angulation, followed by single-stage internal fixation. This case series describes 3 cases of correction of fracture malunion of the lower limb managed using combined CCO and intramedullary nail stabilization. CASE REPORT Case 1: A 47-year-old man with a 17° varus deformity of the left tibia from a past accident had left knee pain. CCO was performed, achieving bone union in 4 months. The Mikulicz line improved from -11% to 23%, and his knee became pain-free. Case 2: A 59-year-old man with a 19° valgus deformity of the right tibia from a past accident had right knee pain. CCO was performed, achieving bone union in 11 months. The Mikulicz line improved from 119% to 72%, and he could perform daily activities pain-free. Case 3: A 59-year-old man with a complex left distal femoral deformity (25° varus and 15° internal rotation) from a past accident had left knee pain. CCO was performed, achieving bone union in 8 months. The Mikulicz line improved from -52% to 4%, and he started enjoying jogging. CONCLUSIONS We performed CCO combined with intramedullary nail stabilization in 3 cases of post-traumatic angular and rotational malunion, achieving good clinical outcomes. This single-stage surgery is advantageous for bone healing and is cost-effective, making it a viable option for correcting long-bone malunion.