Osteotomy — Distal Femoral Extension Osteotomy

Children's Colorado / Center for Gait and Movement Analysis (CGMA) · CGMA Physical Therapy Team, Children's Colorado

Weight-Bearing

NWB x 3 weeks; partial WB weeks 3-6 if adequate bony healing per MD; CPM option (2-4 hr intervals, 6-8 hrs/day) instead of long leg casts; healing 6-8 weeks

Key Restrictions

No impact, torque, or unprotected WB x 3 weeks; no knee flexion beyond 90 deg x 3 weeks (uncasted); no forceful/resistive quad contraction; minimize fall risk; avoid flexion beyond 90 deg

Timeline & Phases

Phase 1 (days 1-7): NWB (WB for transfers only with immobilizers if needed), pain management, safe transfers, hip/ankle PROM/AAROM/AROM, isometrics; Phase 2 (days 8-21): full passive knee extension, knee flexion to 90 deg, pain management; Phase 3 (days 22-42): progressive WB per MD, ground reaction AFOs for gait, full knee ROM, scar massage, e-stim; Phase 4 (week 7+): gait re-training (knee extension in swing/stance), full LE ROM, LE strengthening (glutes/quads/calves), functional balance

Notes

Pediatric; indication is fixed knee flexion contracture; anterior femoral wedge removed from distal femoral metaphysis with blade plate/side screws; CPM option to minimize surgical tissue scarring; ground reaction AFOs for gait quality; Children's Colorado CGMA

Surgeon / Author

CGMA Physical Therapy Team, Children's Colorado

Published

June 2008