Distal Femoral Osteotomy in Genovalgum: Internal Fixation with Blade Plate Versus Casting

Document Type : RESEARCH PAPER


1 Associated professor of orthopedics, Orthopedic surgeon, Mashhad University of Medical science

2 Mashhad University of Medical Sciences

3 General practitioner, Mashhad University of Medical science


To compare the results of two different ways of distal femoral osteotomy stabilization in patients suffering from genuvalgum: internal fixation with plate, and casting.
In a non-randomized prospective study, after distal femoral osteotomy with the zigzag method, patients were divided into two groups: long leg casting, and internal fixation with blade plate. For all patients, questionnaires   
were filled to obtain data. Information such as range of motion, tibiofemoral anatomical angle and complications were recorded.
38 knees with valgus deformity underwent distal femoral supracondylar osteotomy. (8 with plaster cast and  30 with internal fixation using a blade plate). Preoperative range of motion was 129±6° and six months later it was 
120±14°. The preoperative tibiofemoral angle was 32±6°; postoperative tibiofemoral angles were 3±3°, 6±2°, and 7±3° just after operation, six months, and two years later, respectively. Although this angle was greater among the group stabilized with a cast, this difference was not statistically significant. In postoperative complications, over-correction  was found in five, recorvatom deformity in one, knee stiffness in three and superficial wound infection was recorded in three knees.
There is no prominent difference in final range of motion and alignment whether fixation is done with casting or internal fixation. However, the complication rate seems higher in the casting method.


  1. Amendola A, Bonasia DE. Results of high tibial osteotomy: review of the literature. Int Orthop. 2010; 34(2): 155–60.
  2. 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.
  3. Jackson JP, Waugh W. Tibial osteotomy for osteoarthritis of the knee. Proc R Soc Med. 1960; 53(10): 888.
  4. Mathews J, Cobb AG, Richardson S, Bentley G. Distal femoral osteotomy for lateral compartment osteoarthritis of the knee. Orthopedics. 1998; 21(4):437-40.
  5. Omidi-Kashani F, Hasankhani IG, Mazlumi M, Ebrahimzadeh MH. Varus distal femoral osteotomy in young adults with valgus knee. J Orthop Surg Res. 2009; 4:15.
  6. Puddu G, Cipolla M, Cerullo G, Franco V, Gianni E. Which osteotomy for a valgus knee? Int Orthop. 2010; 34(2): 239–47.
  7. Haddad FS, Bentley G. Total knee arthroplasty after high tibial osteotomy: a medium-term review. J Arthroplasty. 2000; 15(5):597-603.
  8. Saithna A, Kundra R, Modi CS, Getgood A, Spalding T. Distal femoral varus osteotomy for lateral compartment osteoarthritis in the valgus knee. A systematic review of the literature. Open Orthop J. 2012; 6:313-9.
  9. Thein R, Bronak S, Thein R, Haviv B. Distal femoral osteotomy for valgus arthritic knees. J Orthop Sci. 2012; 17(6):745-9.
  10. Wang JW, Hsu CC. Distal femoral varus osteotomy for osteoarthritis of the knee. J Bone Joint Surg Am. 2005; 87(1):127-33.
  11. Pach M, Uvizl M, Holibka R, Zapletalova J. Varus supracondylar osteotomy of the femur -- long-term results. Acta Chir Orthop Traumatol Cech. 2005; 72(6):363-70.
  12. Sherman C, Cabanela ME. Closing wedge osteotomy of the tibia and the femur in the treatment of gonarthrosis. Int Orthop. 2010; 34(2):173-84.