[Medial closed wedge osteotomy of the distal femur in biplanar technique and a specific plate fixator]

Abstract

Objective: Correction of distal femur deformity by closed-wedge biplanar osteotomy.

Indications: Metaphyseal frontal plane deformities of the femur.

Contraindications: Osteoarthritis of the contralateral compartment, total loss of the contralateral meniscus, acute/chronic infection, limited range-of-motion, poor soft-tissue conditions at site of surgery.

Surgical technique: Skin incision at metaphyseal area of femur. Local exposure of bone. Marking of planned osteotomies. Incomplete posterior osteotomies, complete anterior osteotomy. Wedge removal and closure. Radiological control of alignment. Fixation with specific plate fixator for the medial femur (TomoFix MDF). Submuscular plate fixation. Wound closure.

Postoperative management: Elastic bandage, suction drain removal and walking with crutches on day 1. Partial weight bearing (15 kg) for the first 4 weeks; X‑ray control on day 3 and 4 weeks after surgery, walking without crutches depending on healing of osteotomy. Thrombosis prophylaxis.

Results: From January 2005 to October 2008, 60 patients were treated. Average wedge size 7.6 mm; age 39.7 years; mean follow-up 21 months; 7 revision surgeries: 3 delayed/nonunion of the osteotomy, one superficial infection, one deep infection, one hematoma, and one fracture proximal of the internal plate fixator. Tegner activity score pre‑/postoperative 2.8 (1-4)/5.6 (2-9); VAS score pre‑/postoperative 6.8 (2-9)/3.1 (0-8). From 2014-2015, 107 femur osteotomies performed: 4 delayed healing, one plate breakage. Healing of all other osteotomies in 4-6 weeks. No loss of range-of-motion with the muscle-sparing surgical technique.

Keywords: Internal fixators; Knee joint; Osteoarthritis; Valgus deformity.