Wedge-less oblique supracondylar femoral osteotomy and casting for genu valgum in older children and young adults

Abstract

Background: Genu valgum is one of the commonest deformities seen by the orthopaedicians. The most common cause is idiopathic but genu valgum secondary to nutritional deficiency is also fairly common in developing and third world countries. Supracondylar osteotomy and internal fixation with plate and screws, is the treatment of choice in older children and young adults, which is costly, requires a wide exposure, a second surgery for implant removal and risk of infection is more. This study was undertaken to measure the outcome of simple oblique percutaneous wedge-less metaphyseal supracondylar osteotomy of the distal femur and casting in older children and adolescents with Genu Valgum in a small centre catering mostly to patients from middle and low income households. Patients and methods: Patients aged between 12 and 22 years with genu valgum deformity with a tibiofemoral angle 15 , and an intermalleolar distance of more than 7 cm in unilateral and more than 10 cm in bilateral cases, who are not amenable to be treated with guided growth techniques, were included. Patients having knee instability, restriction of knee range of motion, genu recurvatum, tibial deformity component, open physis, were excluded from the study. The correction was undertaken by a simple supracondylar wedge-less metaphyseal short oblique osteotomy of the distal femur followed by immobilization with a long leg plaster of Paris cast. Functional outcome was assessed using B€ ostman et al. score. Results: 46 limbs in 29 patients with a mean age of 14.5 years were operated. The mean follow-up of patients was 6 months. The preoperative radiological tibiofemoral angle (TFA) had a mean value of 19.89 which improved to a mean of 5.31 postoperatively. Intermalleolar distance (IMD) improved from a mean of 13.81 cm to 3.15 cm post-correction. Mean Lateral distal femoral angle (LDFA) improved from 77.11 to 87.20 . Knee score was excellent in all patients at 3 months and 6 months post intervention. There were no serious complications except superficial plaster sores in 4 patients, which healed uneventfully and temporary restriction of knee range of motion in 5 patients. All patients achieved a full range of knee motion after physical therapy. Conclusion: Supracondylar wedge-less short oblique metaphyseal distal femoral osteotomy and immobilization with plaster of Paris cast is a simple, cheap, safe & viable option for the correction of genu valgum deformity originating from distal femur, with minimal complications in older children and adolescents with limited growth potential, especially in low income countries and small centres.

Comparative analysis of clinical and functional outcomes in late adolescents with genu valgum undergoing corrective osteotomy: a study of K-wire fixation versus plate osteosynthesis

“…The procedure, ideal for low-income settings, had minimal complications, with all patients regaining full knee motion after physical therapy proving the need for minimal fixation following distal femoral osteotomies. 20 Sidhu et al their study on adolescent patients with valgus knee deformities evaluated the effectiveness of wedge less distal femoral V osteotomy stabilized with K-wires. Preoperative TFA averaged 20.23±3.63 degrees, decreasing significantly to 5.5±0.73 at six months postsurgery, alongside reduced IMD and MAD.…”

Impact of Intensive Physiotherapy on an Adolescent with Severe Genu Valgum Deformities: A Case Report

“…The knee connects the shin bone (tibia) to the proximal end of the thigh bone (femur) [1]. Genu valgum is most usually noted as a knock-knee [2]. Genu valgum is one of the lower extremity anomalies in the coronal plane (knocked knees) [3].…”