Deformity correction
Rotational deformity (in-toeing & out-toeing)
Rotational deformity lies in the rotational plane of the femur or tibia, producing in-toeing or out-toeing gait. It is often missed because plain radiographs do not show it. Treatment is a derotational osteotomy, which can be combined with angular correction using the SADO technique.
Who it suits
- Visible in-toeing or out-toeing gait
- Patients whose legs still look unnatural after angular correction
Technique highlights
- CT torsion measurement first, so the correction angle is exact
- Correctable together with angular deformity in one SADO operation
Surgical steps
- Gait assessment and CT torsion measurement.
- Osteotomy and derotation to the calculated angle.
- Internal fixation, then physiotherapy.
Recovery & aftercare
- Similar to other realignment surgery, with no cast when internal fixation is used.
Risks & things to consider
- Bone lengthening is major surgery. Outcome and recovery time depend on bone quality, age, weight and how disciplined the patient is with rehabilitation, so identical results cannot be guaranteed.
- Daily physiotherapy is mandatory through both the lengthening and consolidation phases. Skipping it risks joint stiffness, muscle contracture or delayed bone healing.
- Disclose all medical conditions, regular medication, previous bone surgery and drug allergies at the consultation, and stop smoking before and after surgery as instructed — nicotine measurably slows bone healing.
Frequently asked questions
Why doesn't a normal X-ray show torsion?
A plain X-ray is a two-dimensional frontal image, so it shows angular deformity only. Torsion must be measured on CT or 3D imaging, which the institute uses alongside EOS for surgical planning.
Other procedures in this area
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