Novel Approach for Closed Femoral Shortening Osteotomy with Deformity Correction Using Reverse Planning and Retrograde Surgical Technique

Aug 30, 2026

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A retrograde femoral shortening technique is presented to enable simultaneous deformity correction using an intramedullary nail. Leg length discrepancy can be addressed by lengthening the shorter limb or shortening the longer limb, either gradually or acutely, yet combined femoral shortening with deformity correction via a retrograde nail has not been described in prior literature. A modified Baumgart reverse-planning method guides intraoperative guidewire placement, cortical contact, percutaneous shortening osteotomy, and alignment control with locking and poller screws. Clinical results support a safe, technically straightforward, and effective option for managing LLD with femoral deformity in the longer limb.

LanguageEnglish

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Pages5

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Abstract

Aim and Background

Technique

Conclusion and Clinical Significance

Introduction

Case Description

Planning

CLINICAL TECHNIQUE Novel Approach for Closed Femoral Shortening Osteotomy with Deformity Correction Using Reverse Planning and Retrograde Surgical Technique Bartosz Musielak1, James A Fernandes2 Received on: 05 November 2025; Accepted on: 03 December 2025; Published on: 16 January 2026 AbstrAct Aim: To describe a retrograde femoral shortening technique that allows simultaneous deformity correction over an intramedullary nail. Background: Leg length discrepancy (LLD) can be managed by lengthening the short limb or shortening the long limb, either gradually or acutely. To our knowledge, the combined femoral shortening and deformity correction using a retrograde nail has not been previously reported in the literature. Technique: Shortening and correction are planned using a modified Baumgart reverse-planning method. Based on the planning, the position of the guidewire is replicated intraoperatively. After achieving the “cortical contact” point, further steps are taken for the nail insertion. A percutaneous shortening osteotomy is then performed, with bone and nail alignment controlled using locking and poller screws. Conclusion: This report outlines a reproducible retrograde technique for femoral shortening osteotomy with concurrent deformity correction. Clinical significance: This method provides a safe, technically straightforward, and effective option for treating LLD with associated femoral deformity in the longer limb. Keywords: Leg length discrepancy, Percutaneous osteotomy, Reverse planning, Shortening osteotomy. Strategies in Trauma and Limb Reconstruction (2025): 10.5005/jp-journals-10080-1652 IntroductIon Over the years, advancements in limb recon technologies have lowered the threshold for leg length discrepancy (LLD) treatment with lengthening procedures.1 Shortening of the contralateral limb is, however, still a viable option for managing LLD, especially in patients with contraindications for lengthening or in patients requiring multiple lengthening of the shorter side to facilitate achieving equal length with fewer number of complications. Due to the complexity of the tibial segment, shortening osteotomies are most commonly performed in the femur. Although the surgical approach to these osteotomies has been established decades ago and percutaneous ways of performing it were well described, to date, there have been no reports on simultaneous deformity correction combined with femoral shortening.2–10 Retrograde nailing technique for femoral deformity correction and lengthening is well established.11–15 A similar approach may be applied in patients with LLD requiring both shortening osteotomy and deformity correction. Thus, the aim of this article is to present a novel technique of reverse surgical planning and execution for simultaneous deformity correction with bone shortening for limb length discrepancy, using intramedullary fixation and percutaneous shortening techniques. cAse descrIptIon A 15-year-old girl with limb length discrepancy of 6 cm who had previously been treated for lymphoblastic leukaemia, complicated by severe pseudomonas septicaemia with significant soft-tissue loss requiring skin grafts, which resulted in progressive left leg shortening (Fig. 1A). 1Department of Paediatric Orthopedics and Traumatology, Dega Institute, Poznan, Woj. Wielkopolskie, Poland 2Department of Trauma and Orthopaedics, Sheffield Children’s Hospital NHS Trust, Sheffield, United Kingdom Corresponding Author: Bartosz Musielak, Department of Paediatric Orthopedics and Traumatology, Dega Institute, Poznan, Poland, Phone: +48600302158, [e-mail: ortopediadziecieca@gmail.com](e-mail: ortopediadziecieca@gmail.com)[ ](e-mail: ortopediadziecieca@gmail.com)[How to cite this article:](How to cite this article: Musielak B)[ Musielak B](How to cite this article: Musielak B), Fernandes JA. Novel Approach for Closed Femoral Shortening Osteotomy with Deformity Correction Using Reverse Planning and Retrograde S

FAQs

What problem does the technique target?

It targets leg length discrepancy (LLD) in the longer limb when femoral deformity also needs correction.

How does reverse planning guide the surgery?

A modified Baumgart reverse-planning method is used on long-leg radiographs, and the guidewire position is replicated intraoperatively.

How is alignment controlled during femoral shortening?

Alignment of the bone and nail is controlled using locking and poller screws after the percutaneous shortening osteotomy.

Aug 30, 2026

Upload by Liam