Distal Femoral Osteotomy: Is Internal Fixation Better than External?

Seah, Matthew; Shafi, Raheel; Fragomen, Austin T.; Rozbruch, S. Robert

doi:10.1007/s11999-010-1755-0

Cited by 53 publications

(19 citation statements)

References 39 publications

(53 reference statements)

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“…Seah et al retrospectively evaluated 26 patients in which they performed a DFO stabilized with either fixatorassisted plating or a unilateral frame, and they evaluated the accuracy of correction. The authors concluded that an accurate correction was obtained with both techniques, so the method of fixation should be left to the discretion of the surgeon and needs of the patient [59].…”

Section: Resultsmentioning

confidence: 99%

Distal femoral osteotomy

Rosso¹,

Margheritini

2014

Curr Rev Musculoskelet Med

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Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. There are few papers in the literature describing the outcomes of distal femoral osteotomy (DFO), as compared with the studies reporting on high tibial osteotomy (HTO), probably because valgus malalignment is less common than the varus one. There is still debate as to what the correct indication is and which surgical techniques lead to the best outcomes in performing a DFO. Besides, it is still controversial whether patellofemoral arthritis should be considered as a contraindication to performing a DFO, as well as in HTO. In this article, we will summarize the indications for DFO, the surgical techniques reported in the literature, and their outcomes.

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Section: Resultsmentioning

confidence: 99%

Distal femoral osteotomy

Rosso¹,

Margheritini

2014

Curr Rev Musculoskelet Med

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“…In contrast to previous studies where the osteotomy was fixed using an external fixator [ 5 ], we have used plates and screws to avoid tethering of the quadriceps, pin track infections, loosening and the use of a cumbersome device. In a comparative study of internal versus external fixation for distal femoral osteotomies, Seah et al [ 13 ] found no significant differences and concluded that the fixation method should be left to the discretion of the surgeon. This work coincides with the work of Wang and Hsu who used 90° blade-plates and screws for osteotomy fixation; the use of femoral condylar buttress or “T” plates is, in our view, easier and requires a less difficult after-care period.…”

Section: Discussionmentioning

confidence: 99%

Femoral supracondylar focal dome osteotomy with plate fixation for acute correction of frontal plane knee deformity

Ghazaly

Elmoatasem

2015

Strategies in Trauma and Limb Reconstruction

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Focal dome osteotomy (FDO) allows deformity correction without secondary translational deformity. The purpose of this study was to evaluate the degree of correction and knee functional outcome after correction of frontal knee deformity using femoral supracondylar FDO fixed with plate and screws. A prospective study included 12 consecutive cases of femoral frontal plane deformity that underwent correction using supracondylar focal osteotomy fixed by plate and screws. Average age was 27 years, while mean follow-up was 2.1 years. Functional assessment was done using the Hospital for Special Surgery (HSS) knee score. The HSS knee score improved from 85 to 96.8 points. Desired correction was achieved in all cases. Postoperative mechanical axis analysis on long film and scanogram showed no secondary deformity. The overall postoperative mechanical axis was at 3.2 mm medially (range 2–5 mm). Autogenous bone graft was not used in any case, and uneventful osteotomy union was achieved at a mean of 13.8 weeks. Minor complications were encountered in two cases. There were no implant failures or reoperations. Supracondylar FDO of the femur with plate fixation is a reproducible technique that can produce full correction of distal femoral frontal plane deformity, while avoiding creating a secondary deformity. Knee function was improved with good patient satisfaction.

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“…Multiple surgical techniques and methods of fixation have been used for osteotomy correction including intramedullary nails, plate and screw constructs, or hexapod external frames. 32 Internal lengthening intramedullary nails can be particularly useful if there is both an angular deformity and an LLD. Distal femoral and proximal tibial plates can be used and are frequently removed before or at the time of the arthroplasty procedure ( Figure 6).…”

Section: Surgical Technique and Implant Choice For Extraarticular Ostmentioning

confidence: 99%

Management of Extra-articular Deformity in the Setting of Total Knee Arthroplasty

Sculco

Kahlenberg

Fragomen

et al. 2019

J Am Acad Orthop Surg

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Extra-articular deformities of the femur and tibia in conjunction with advanced knee osteoarthritis pose unique challenges for the arthroplasty surgeon. Careful preoperative planning is needed to evaluate both the intra-and extra-articular deformities and to determine the best route to total knee arthroplasty. An intra-articular compensatory correction can typically be performed if the extraarticular deformity is distant from the joint or if preoperative templating shows that bony cuts do not interfere with ligamentous attachments. Staged osteotomy followed by arthroplasty is beneficial in severe cases in which bony cuts are excessive or would interfere with softtissue structures and in cases with leg-length discrepancy. Osteotomies can be performed percutaneously and fixed with intramedullary nails, external fixators, or plate and screw constructs. Ligamentous laxity after correction and risk of peroneal nerve injury are increased in extra-articular deformity cases and must be considered during the knee arthroplasty procedure with increased implant constraint and patient counseling, respectively. Computerassisted navigation has an emerging role in total knee arthroplasty in patients with extra-articular deformity. M ore than 700,000 total knee arthroplasties (TKAs) are performed annually in the United States. 1 Although correction of intra-articular pathology is a mainstay of TKA, less has been published on the evaluation and management of extra-articular deformity in the setting of TKA. An extra-articular deformity may be a result of previous trauma or skeletal developmental abnormalities and may increase the risk of knee osteoarthritis. 2 Thus, orthopaedic surgeons should be aware of the diagnosis and treatment algorithms for extraarticular deformity in the setting of TKA. Performing a TKA without addressing underlying extra-articular malalignment may place the patient at risk of ongoing pain and early implant failure. 3 The purpose of this article is to present treatment algorithms for the management of extra-articular deformity in either the femur or tibia and in the coronal, sagittal, or axial plane and to review the radiographic imaging, surgical planning, and multidisciplinary approach necessary to optimize clinical outcomes and minimize arthroplasty failure. Causes of Extra-articular Deformity of the Femur and Tibia and Its Association With Knee Osteoarthritis Causes of extra-articular deformity of the femur and tibia are numerous

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Distal Femoral Osteotomy: Is Internal Fixation Better than External?

Abstract: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Cited by 53 publications

References 39 publications

Distal femoral osteotomy

Distal femoral osteotomy

Femoral supracondylar focal dome osteotomy with plate fixation for acute correction of frontal plane knee deformity

Management of Extra-articular Deformity in the Setting of Total Knee Arthroplasty

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