The Clamshell Osteotomy: A New Technique to Correct Complex Diaphyseal Malunions

Russell, George V.; Graves, Matt L.; Archdeacon, Michael T.; Barei, David P.; Brien, Jr., Glenn A.; Porter, Scott E.
February 2009
Journal of Bone & Joint Surgery, American Volume;Feb2009, Vol. 91-A Issue 2, p314
Academic Journal
Background: The treatment of complex diaphyseal malunions is challenging, requiring extensive preoperative planning and precise operative technique. We have developed a simpler method to treat some of these deformities. Methods: Ten patients with complex diaphyseal malunions (including four femoral and six tibial malunions) underwent a clamshell osteotomy. The indications for surgery included pain at adjacent joints and deformity. After surgical exposure, the malunited segment was transected perpendicular to the normal diaphysis proximally and distally. The transected segment was again osteotomized along its long axis and was wedged open, similar to opening a clamshell. The proximal and distal segments of the diaphysis were then aligned with use of an intramedullary rod as an anatomic axis template and with use of the contralateral extremity as a length and rotation template. The patients were assessed clinically and radiographically at a mean of thirty-one months (range, six to fifty-two months) after the osteotomy. Results: Complete angular correction was achieved in each case; the amount of correction ranged from 2° to 20° in the coronal plane, from 0° to 32° in the sagittal plane, and from 0° to 25° in the axial plane (rotation). Correction of length ranged from 0 to 5 cm, and limb length was restored to within 2 cm in all patients. All osteotomy sites were healed clinically by six months. While no deep infections occurred, superficial wound dehiscence occurred in two patients along the approach for the longitudinal portion of the osteotomy, emphasizing the importance of careful soft- tissue handling and patient selection. Conclusions: The clamshell osteotomy provides a useful way to correct many forms of diaphyseal malunion by realigning the anatomic axis of the long bone with use of a reamed intramedullary rod as a template. This technique provides an alternative that could decrease preoperative planning time and complexity as well as decrease the need for intraoperative osteotomy precision in a correctly chosen subset of patients with diaphyseal deformities. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


Related Articles

  • ERRATA.  // Journal of Bone & Joint Surgery, American Volume;May2003, Vol. 85-A Issue 5, p912 

    Presents corrections to articles published in the May 1, 2003-issue of 'The Journal of Bone and Joint Surgery.'

  • The Case Report Redefined with JBJS Case Connector. Swiontkowski, Marc F.; Tolo, Vernon T. // Journal of Bone & Joint Surgery, American Volume;1/16/2013, Vol. 95-A Issue 2, p97 

    An introduction to the journal is presented in which the editor discusses case reports related to bone and joint surgery published within the issue.

  • Learning How to Resurface Cam-Type Femoral Heads with Acceptable Accuracy and Precision: The Role of Computed Tomography-Based Navigation. Cobb, Justin P.; Kannan, Vijayaraj; Dandachli, Wael; Iranpour, Farhad; Brust, Klaus U.; Hart, Alister J. // Journal of Bone & Joint Surgery, American Volume;Aug2008 Supplement 3, Vol. 90-A, p57 

    Background: Resurfacing arthroplasty for cam-type deformities, which are a common cause of early osteoarthritis, is a technically demanding operation. Like any other arthroplasty, it requires both accuracy and precision. On the basis of the results of series reported by expert surgeons, we...

  • Letters to The Editor. Attarian, David E.; Starr, Adam J.; Tolo, Vernon T.; Bednar, Drew A.; Einhorn, Thomas A.; McAfee, Paul C.; Daniels, Tim R.; Toolan, Brian C.; Sangeorzan, Bruce J.; Ritter, Merrill A.; Faris, Philip M.; Meding, John B.; Keating, E. Michael; Berend, Michael; Smith, Stephen W.; Harris, William H.; Parker, Paul; Kahler, David M.; Zura, Robert // Journal of Bone & Joint Surgery, American Volume;Feb2001, Vol. 83-A Issue 2, p293 

    Presents letters to the editor of 'The Journal of Bone & Joint Surgery' concerning articles published in the periodical. Role of team physician; Treatment of multiple closed fractures; Post-operative pain in animals used in research.

  • Letters to The Editor.  // Journal of Bone & Joint Surgery, American Volume;Jul2001, Vol. 83-A Issue 7, p1107 

    Presents letters to the editor of the periodical 'The Journal of Bone & Joint Surgery.' Symptoms and diagnosis of bone tumors; Comparison of methods for prediction of lower-extremity growth; Comparison between mobile-bearing and fixed-bearing knees.

  • THE ORTHOPAEDIC CALENDAR.  // Journal of Bone & Joint Surgery, American Volume;Jul2002, Vol. 84-A Issue 7, p1289 

    Presents schedule of conferences pertaining to bone and joint surgery as of 2002. 'World Congress of Biomechanics,' on August 4 to 9 in Calgary, Alberta; 'Advances in Tissue Engineering,' on August 14 to 17 in Houston, Texas; 'American Association of Electrodiagnostic Medicine,' on October 9-13...

  • Letters to The Editor.  // Journal of Bone & Joint Surgery, American Volume;Oct2002, Vol. 84-A Issue 10, p1889 

    Comments on articles published in the 'Journal of Bone and Joint Surgery.' Malignant transformation of a calcifying aponeurotic fibroma; Errors in the description of the Ponseti technique for correction of congenital clubfoot; Complication rates of scalene regional anesthesia.

  • The Influence of Glenohumeral Prosthetic Mismatch on Glenoid Radiolucent Lines. Walch, Gilles; Edwards, T. Bradley; Boulahia, Aziz; Boileau, Pascal; Molé, Daniel; Adeleine, Patrice // Journal of Bone & Joint Surgery, American Volume;Dec2002, Vol. 84-A Issue 12, p2186 

    Background: In shoulder arthroplasty, mismatch is defined as the difference in the radius or diameter of curvature between the humeral head and glenoid components. Recommendations for mismatch have not been substantiated scientifically. The purpose of this study was to evaluate the effect of...

  • A Ganglion of the Anterior Cruciate Ligament Causing Erosion of the Lateral Femoral Condyle. Choi, Nam-hong; Kim, Sung-jae // Journal of Bone & Joint Surgery, American Volume;Dec2002, Vol. 84-A Issue 12, p2274 

    Studies a ganglion of the anterior cruciate ligament causing erosion of the lateral femoral condyle. Key issues of interest; Analysis of pertinent topics and relevant issues; Implications on bone and joint surgery.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics