Closed intramedullary osteotomies of the femur.

Closed intramedullary osteotomies offer a safe way to correct many femoral deformities. It is the safest method for correcting leg length inequality in adults, having a low infection rate and low complication rate. Unfortunately, the procedure, is technically demanding, requiring great attention by two surgeons. The derotational osteotomy is not nearly as complex; it is a relatively simple procedure for a surgeon experienced in closed intramedullary nailing. Correction is adequate with goniometer measurement, but an interlocking nail is necessary to maintain position. Correction of angulatory deformities is more difficult and requires careful study of anteroposterior, lateral, and oblique radiographs to be certain that the procedure is technically possible. Intramedullary bone grafting is frequently necessary for an open wedge. Distal osteotomies are encumbered by nonunion problems.