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Updated 2026 Distal Femoral Osteotomy Technique
Dr. Garcia specializes in complex knee, shoulder and elbow sports surgeries. He has prepared a number of surgical videos below to help patients better understand their procedures. He is frequently updating his surgical video database so check back soon for further updates.
In this updated video, Dr. Grant H. Garcia demonstrates a Distal Femoral Osteotomy (DFO) technique featuring a biplanar cut, a protective percutaneous hinge pin, and a final headless compression hinge screw. This specialized configuration is utilized for corrections with an opening of 8 mm or greater to mitigate the risk of an intra-operative hinge fracture.
The procedure is outlined in the following surgical phases:
- Exposure & Tracking: The leg is positioned in a specialized holder, allowing the posterior soft tissues to drop away cleanly and offering optimized anterior and posterior working room. Radiamist retractors are placed both anteriorly and posteriorly to ensure full structural visualization during the bone work.
- Biplanar Osteotomy Cut: Two guide pins are placed at the target correction angle under fluoroscopy. Dr. Garcia performs a biplanar cut using a TPS saw for finer, more controlled passes. The osteotomy is extended cautiously toward the opposite cortex using an osteotome, stopping less than 1 cm away from the edge to preserve the native hinge. During the critical posterior cut, a retractor shields the nearby neurovascular bundle while the surgeon's finger tracks the periosteum inferiorly.
- Percutaneous Hinge Pinning: To safeguard the bony hinge prior to opening the gap, a percutaneous wire is drilled from the opposite side directly through the vertex of the hinge.
- Sequential Wedging & Plate Fixation: The DFO site is slowly and sequentially cranked open. A laminar spreader is packed posteriorly to maintain the opening, which is confirmed with a mechanical alignment rod. The fixation plate is applied across the gap, pinned, and initially compressed using a cortical screw to draw the plate flush to the femoral shaft before locking screws are added.
- Compression Hinge Screw Insertion: With the plate secure, the initial percutaneous hinge wire is swapped for a smaller target guide wire. The depth and angle are verified on a lateral fluoroscopy view. A headless compression screw is then driven percutaneously across the hinge site, burying it completely into the bone. This screw adds immediate structural stability, allowing for an earlier post-operative weight-bearing protocol.
- Closure: The lateral X-rays verify a clean biplanar cut and a well-stabilized gap. The open wedge defect is packed with bone graft to complete the procedure.
