Supracondylar Osteotomy in Valgus Knee: Angle Blade Plate Versus Locking Compression Plate

Document Type : RESEARCH PAPER

Authors

1 Bone Joint and Related Tissue Research Center, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Clinical Research Development Center, Babol University of Medical Sciences, Babol, Iran

Abstract

 
Background: There are few studies comparing the biomechanical properties of angled blade plate and locking compression plates in supracondylar osteotomy. In the current randomized study, we prospectively compared the clinical and radiological outcomes of supracondylar osteotomy using these two plates.

Methods: Forty patients with valgus knee malalignment were randomly assigned to two equal numbered groups: angled blade plate and locking compression plates. All of the patients underwent medial closing wedge supracondylar osteotomy and were followed for one year. Before and after the operation the valgus angle and mechanical lateral distal femoral angle were compared between groups. Also, the rate of complications were compared.

Results: After the operation, the mean valgus angle and mechanical lateral distal femoral angle improved significantly in the two groups (P<0.001). Although, the preoperative amount of the valgus angle and mechanical lateral distal femoral angle were the same, at the last visit the valgus angle (5.4±2.1 versus 3.1±1.8; P=0.032) and mechanical lateral distal femoral angle (87.6±2 versus 89.7±3.2; P=0.041) were significantly lower and higher in the angled blade plate group, respectively. Nonunion occurred in four patients (20%) in the locking compression plates group (P=0.35).

Conclusion: Based on having a larger valgus angle and mechanical lateral distal femoral angle correction in the angled blade plate group and considerable rate of nonunion in the locking compression plate group, the authors recommend using the angled blade plate for fixation of medial closing wedge supracondylar osteotomy for patients with valgus malalignment. However, more long-term studies are required.

Keywords

References

  1. El Ghazaly SA, El-Moatasem el-HM. Femoral supracondylar focal dome osteotomy with plate fixation for acute correction of frontal plane knee deformity. Strategies Trauma Limb Reconstr. 2015; 10(1):41-7.
  2. Aglietti P, Menchetti PP. Distal femoral varus osteotomy in the valgus osteoarthritic knee. Am J Knee Surg. 2000; 13(2):89-95.
  3. Finkelstein JA, Gross AE, Davis A. Varus osteotomy of the distal part of the femur. A survivorship analysis. J Bone Joint Surg Am. 1996; 78(9):1348-52.
  4. Kosashvili Y, Safir O, Gross A, Morag G, Lakstein D, Backstein D. Distal femoral varus osteotomy for lateral osteoarthritis of the knee: a minimum ten-year follow-up. Int Orthop. 2010; 34(2):249-54.
  5. Makhmalbaf H, Moradi A, Ganji S. Distal femoral osteotomy in genuvalgum: internal fixation with blade plate versus casting. Arch Bone Jt Surg. 2014; 2(4):246-9.
  6. Batista BB, Volpon JB, Shimano AC, Kfuri M Jr. Varization open-wedge osteotomy of the distal femur: comparison between locking plate and angle blade plate constructs. Knee Surg Sports Traumatol Arthrosc. 2014; 23(8):2202-7.
  7. Puddu G, Cipolla M, Cerullo G, Franco V, Giannì E. Which osteotomy for a valgus knee? Int Orthop. 2010; 34(2):239-47.
  8. Yercan HS, Okcu G, Aydogdu S, Ozic U. Clinical results of lateral closing wedge high tibial osteotomy for osteoarthritis of the knee (Oblique osteotomy with tension band fixation). Acta Orthop Traumatol Turc. 2004; 38(2):89-95.
  9. Paccola CA, Fogagnolo F. Open-wedge high tibial osteotomy: a technical trick to avoid loss of reduction of the opposite cortex. Knee Surg Sports Traumatol Arthrosc. 2005; 13(1):19-22.
  10. Staubli AE, De Simoni C, Babst R, Lobenhoffer P. TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia--early results in 92 cases. Injury. 2003; 34(Suppl 2):B55-62.
  11. Vallier HA, Immler W. Comparison of the 95-degree angled blade plate and the locking condylar plate for the treatment of distal femoral fractures. J Orthop Trauma. 2012; 26(6):327-32.
  12. Brunner R, Camathias C, Gaston M, Rutz E. Supracondylar osteotomy of the paediatric femur using the locking compression plate: a refined surgical technique. J Child Orthop. 2013; 7(6):571-4.
  13. Shoji H, Insall J. High tibial osteotomy for osteoarthritis of the knee with valgus deformity. J Bone Joint Surg Am. 1973; 55(5):963-73.
  14. Coventry MB. Proximal tibial varus osteotomy for osteoarthritis of the lateral compartment of the knee. J Bone Joint Surg Am. 1987; 69(1):32-8.
  15. Coventry MB. Osteotomy about the knee for degenerative and rheumatoid arthritis. J Bone Joint Surg Am. 1973; 55(1):23-48.
  16. Rosso F, Margheritini F. Distal femoral osteotomy. Curr Rev Musculoskelet Med. 2014; 7(4):302-11.17.
  17. Franco V, Cipolla M, Gerullo G, Gianni E, Puddu G. Open wedge osteotomy of the distal femur in the valgus knee. Orthopade. 2004; 33(2):185-92.
  18. Stähelin T, Hardegger F. Incomplete supracondylar femur osteotomy. A minimally invasive compression osteosynthesis with soft implant. Orthopade. 2004; 33(2):178-84.
  19. Brinkman JM, Hurschler C, Agneskirchner JD, Freiling D, van Heerwaarden RJ. Axial and torsional stability of supracondylar femur osteotomies: biomechanical comparison of the stability of five different plate and osteotomy configurations. Knee Surg Sports Traumatol Arthrosc. 2011; 19(4):579-87.
  20. Omidi-Kashani F, Hasankhani IG, Mazlumi M, Ebrahimzadeh MH. Varus distal femoral osteotomy in young adults with valgus knee. J Orthop Surg Res. 2009; 4(10):15-20.
  21. Wang JW, Hsu CC. Distal femoral varus osteotomy for osteoarthritis of the knee. J Bone Joint Surg Am. 2005; 87(1):127-33.
  22. Learmonth ID. A simple technique for varus supracondylar osteotomy in genu valgum. J Bone Joint Surg Br. 1990; 72(2):235-7.
  23. McDermott AG, Finklestein JA, Farine I, Boynton EL, MacIntosh DL, Gross A. Distal femoral varus osteotomy for valgus deformity of the knee. J Bone Joint Surg Am. 1988; 70(1):110-6.
  24. Stähelin T, Hardegger F, Ward JC. Supracondylar osteotomy of the femur with use of compression. Osteosynthesis with a malleable implant. J Bone Joint Surg Am. 2000; 82(5):712-22.
  25. Sommer C, Gautier E, Müller M, Helfet DL, Wagner M. First clinical results of the Locking Compression Plate (LCP). Injury. 2003; 34(Suppl 2):B43-54.
  26. Stoffel K, Lorenz KU, Kuster MS. Biomechanical considerations in plate osteosynthesis: the effect of plate-to-bone compression with and without angular screw stability. J Orthop Trauma. 2007; 21(6):362-8.
  27. Vallier HA, Hennessey TA, Sontich JK, Patterson BM. Failure of LCP condylar plate fixation in the distal part of the femur. A report of six cases. J Bone Joint Surg Am. 2006; 88(4):846-53.
  28. Karunakar MA, Kellam JF. Avoiding malunion with 95degrees fixed-angle distal femoral implants. J Orthop Trauma. 2004; 18(7):443-5.
  29. Pascarella R, Bettuzzi C, Bosco G, Leonetti D, Dessì S, Forte P, et al. Results in treatment of distal femur fractures using polyaxial locking plate. Strategies Trauma Limb Reconstr. 2014; 9(1):13-8.
  30. Ebraheim NA, Liu J, Hashmi SZ, Sochacki KR, Moral MZ, Hirschfeld AG. High complication rate in locking plate fixation of lower periprosthetic distal femur fractures in patients with total knee arthroplasties. J Arthroplasty. 2012; 27(5):809-13.
  31. Samani SS, Kachooei AR, Ebrahimzadeh MH, Omidi Kashani F, Mahdavian Naghashzargar R, Razi S. Application of Orthopedic Dual Sliding Compression Plate (ODSCP) in High Medial Tibial Open Wedge Osteotomies. Iran Red Crescent Med J. 2013; 15(4):335-9.
The Archives of Bone and Joint Surgery
Volume 4, Issue 1 - Serial Number 1
January 2016
Pages 29-34

Files

History

  • Receive Date: 12 August 2015
  • Revise Date: 18 November 2015
  • Accept Date: 22 November 2015

Share

How to cite

Statistics