Is wedge less distal femoral osteotomy adequate for correction of genu valgus deformity?

Purpose. The aims of this study were to (1) examine the timeline of return to sport (RTS) following isolated lateral opening wedge distal femoral osteotomy (DFO), (2) evaluate the degree of participation on RTS, and (3) identify risk factors for failure to RTS. Methods. Nineteen consecutive patients undergoing isolated lateral opening wedge DFO were reviewed retrospectively at a minimum of 2 years postoperatively. Patients completed a sports questionnaire, visual analogue scale for pain (VAS-Pain), Single Assessment Numerical Evaluation (SANE), and a satisfaction questionnaire. Results. Seventeen patents (89.5%; age 32.1 ± 10.1 years; gender 9 males, 52.9%) were contacted at 7.3 ± 4.4 years (range 2.0-13.8 years). Twelve patients (70.6%) resumed playing ≥1 sport at an average time of 9.5 ± 3.3 months (range 3-12 months). Of these 12 patients, 6 returned to a lower level of participation (50.0%). Seven patients (41.2%) had returned to the operating room for further surgery, which included removal of hardware (5.9%) and total knee arthroplasty (5.9%). The average VAS-Pain, SANE, and Marx scores were 3.4 ± 2.6 (range 0-8), 56.2 ± 18.7 (range 20-85), and 5.0 ± 5.3 (range 0-16), respectively. Fourteen patients (82.4%) were at least somewhat satisfied with their procedure. Conclusion. In patients with isolated lateral compartment osteoarthritis and valgus deformity, lateral opening wedge DFO allows 70.6% of patients to RTS by 9.5 ± 3.3 months. However, most patients may be unable to return to their presymptomatic level of function. Patient expectations regarding RTS can be appropriately managed with adequate preoperative patient education. Level of Evidence. IV, case series.

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Dislocated hinge fractures are associated with malunion after lateral closing wedge distal femoral osteotomy

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-021-06466-2 ◽

2021 ◽

Author(s):

Marco-Christopher Rupp ◽

Philipp W. Winkler ◽

Patricia M. Lutz ◽

Markus Irger ◽

Philipp Forkel ◽

...

Keyword(s):

Femoral Osteotomy ◽

Common Finding ◽

Fracture Type ◽

Varus Malalignment ◽

Distal Femoral Osteotomy ◽

Closing Wedge ◽

Increased Risk ◽

Surgical Data ◽

Technical Factors ◽

Hinge Fracture

Abstract Purpose To evaluate the incidence, morphology, and associated complications of medial cortical hinge fractures after lateral closing wedge distal femoral osteotomy (LCW-DFO) for varus malalignment and to identify constitutional and technical factors predisposing for hinge fracture and consecutive complications. Methods Seventy-nine consecutive patients with a mean age of 47 ± 12 years who underwent LCW-DFO for symptomatic varus malalignment at the authors’ institution between 01/2007 and 03/2018 with a minimum of 2-year postoperative time interval were enrolled in this retrospective observational study. Demographic and surgical data were collected. Measurements evaluating the osteotomy cut (length, wedge height, hinge angle) and the location of the hinge (craniocaudal and mediolateral orientation, relation to the adductor tubercle) were conducted on postoperative anterior–posterior knee radiographs and the incidence and morphology of medial cortical hinge fractures was assessed. A risk factor analysis of constitutional and technical factors predisposing for the incidence of a medial cortical hinge fracture and consecutive complications was conducted. Results The incidence of medial cortical hinge fractures was 48%. The most frequent morphological type was an extension fracture type (68%), followed by a proximal (21%) and distal fracture type (11%). An increased length of the osteotomy in mm (53.1 ± 10.9 vs. 57.7 ± 9.6; p = 0.049), an increased height of the excised wedge in mm (6.5 ± 1.9 vs. 7.9 ± 3; p = 0.040) as well as a hinge location in the medial sector of an established sector grid (p = 0.049) were shown to significantly predispose for the incidence of a medial cortical hinge fracture. The incidence of malunion after hinge fracture (14%) was significantly increased after mediolateral dislocation of the medial cortical bone > 2 mm (p < 0.05). Conclusion Medial cortical hinge fractures after LCW-DFO are a common finding. An increased risk of sustaining a hinge fracture has to be expected with increasing osteotomy wedge height and a hinge position close to the medial cortex. Furthermore, dislocation of a medial hinge fracture > 2 mm was associated with malunion and should, therefore, be avoided. Level of evidence Prognostic study; Level IV.

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How the orientation of osteotomy in biplanar lateral closed-wedge distal femoral osteotomy influences the rotational alignment of the knee in all dimensional planes

The Knee ◽

10.1016/j.knee.2021.01.023 ◽

2021 ◽

Vol 29 ◽

pp. 167-173

Author(s):

Hiroshi Nakayama ◽

Ryo Kanto ◽

Tomoya Iseki ◽

Shintaro Onishi ◽

Shunichiro Kambara ◽

...

Keyword(s):

Femoral Osteotomy ◽

Rotational Alignment ◽

Distal Femoral Osteotomy ◽

Closed Wedge

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Medial Closed Wedge Distal Femoral Osteotomy Using a Novel Plate With an Optimal Compression System

Arthroscopy Techniques ◽

10.1016/j.eats.2021.02.016 ◽

2021 ◽

Author(s):

Ryuichi Nakamura ◽

Takenori Akiyama ◽

Ryohei Takeuchi ◽

Hiroshi Nakayama ◽

Eiji Kondo

Keyword(s):

Femoral Osteotomy ◽

Distal Femoral Osteotomy ◽

Compression System ◽

Closed Wedge

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Medial closed-wedge distal femoral osteotomy with local bone grafts for large collapsed steroid-induced osteonecrosis of the lateral femoral condyle: A case report

Journal of Orthopaedic Science ◽

10.1016/j.jos.2021.06.016 ◽

2021 ◽

Author(s):

Takuma Kaibara ◽

Eiji Kondo ◽

Masatake Matsuoka ◽

Koji Iwasaki ◽

Tomohiro Onodera ◽

...

Keyword(s):

Case Report ◽

Femoral Condyle ◽

Bone Grafts ◽

Femoral Osteotomy ◽

Lateral Femoral Condyle ◽

Distal Femoral Osteotomy ◽

Local Bone ◽

Closed Wedge

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Monomelic Maffucci syndrome

BMJ Case Reports ◽

10.1136/bcr-2020-239619 ◽

2021 ◽

Vol 14 (3) ◽

pp. e239619

Author(s):

Gopalkrishna G Verma ◽

Vijay Kumar Jain ◽

Karthikeyan P Iyengar

Keyword(s):

Lower Limb ◽

Corrective Osteotomy ◽

Valgus Deformity ◽

Left Knee ◽

Leg Length ◽

Maffucci Syndrome ◽

Successful Clinical Outcome ◽

Genu Valgus Deformity ◽

Angular Deformities

Maffucci syndrome is a rare congenital, non-hereditary condition characterised by presence of multiple enchondromas and haemangiomas. Enchondromatous lesions affecting epiphysial growth plates can lead to angular deformities and leg-length discrepancy in the lower limb. We describe a 12-year-old girl with monomelic Maffucci syndrome affecting her left lower limb. She presented with progressive genu valgus deformity of her left knee. This caused her to limp during her gait and was a cosmetic dissatisfaction. The deformity affected her quality of life. She underwent a supracondylar distal femoral corrective osteotomy with a successful clinical outcome and restoration of her gait and cosmetic deformity.

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Eight respectively nine out of ten patients return to sport and work after distal femoral osteotomy

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-018-5206-x ◽

2018 ◽

Vol 27 (7) ◽

pp. 2345-2353 ◽

Cited By ~ 11

Author(s):

Alexander Hoorntje ◽

Berbke T. van Ginneken ◽

P. Paul F. M. Kuijer ◽

Koen L. M. Koenraadt ◽

Rutger C. I. van Geenen ◽

...

Keyword(s):

Return To Sport ◽

Femoral Osteotomy ◽

Distal Femoral Osteotomy

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Distal femoral osteotomy for genu valgum deformity caused by malunited Hoffa fracture

BMJ Case Reports ◽

10.1136/bcr-2020-238615 ◽

2021 ◽

Vol 14 (2) ◽

pp. e238615

Author(s):

Taiga Oda ◽

Akira Maeyama ◽

Tetsuro Ishimatsu ◽

Takuaki Yamamoto

Keyword(s):

Internal Fixation ◽

Femoral Condyle ◽

Weight Bearing ◽

Young Patients ◽

Femoral Osteotomy ◽

Posterior Aspect ◽

Distal Femoral Osteotomy ◽

Non Union ◽

Hoffa Fracture ◽

Articular Fractures

Hoffa fractures are unstable intra-articular fractures of the femoral condyle that occur in the coronal plane.Insufficient anatomical reduction and internal fixation may lead to non-union or malunion. A 39-year-old man was involved in a traffic accident while riding a motorcycle and was diagnosed with left Hoffa fracture and avulsion fracture of the femoral attachment of the medial collateral ligament. Open reduction and internal fixation were performed 5 days after injury. The patient experienced intermittent knee pain, joint contracture and deformity, and attended our hospital for further treatment 18 months after surgery. CT revealed depression and malunion of the posterior aspect of the lateral femoral condyle, and weight-bearing X-ray showed valgus deformity due to malunion. Distal femoral osteotomy (DFO) was performed and good functional and radiographic results were obtained. This report suggests that DFO is a reasonable treatment for young patients suffering from malalignment due to malunited Hoffa fracture.

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