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Distal Femoral Osteotomy: Is Internal Fixation Better than External?

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Distal femoral osteotomies (DFO) can be used to correct deformities around the knee. Although osteotomies can be fixed with either internal or external fixation techniques, the advantages of one over the other are unclear.

Questions/purposes

We asked whether (1) for both techniques, we could accurately correct the deformities based on our preoperative goals for mechanical axis deviation (MAD) and lateral distal femoral angle (LDFA), and (2) intraoperative times, (3) preoperative and postoperative knee ROM, and (4) complications differed.

Patients and Methods

We identified 26 patients (34 limbs) who underwent femoral osteotomies. We compared accuracy of correction (based on correction of the MAD and the LDFA), duration of surgery, preoperative and postoperative knee ROM, and complications. The minimum followup was 20 months (mean, 29 months; range, 20–40 months).

Results

We achieved the desired MAD within 10 mm of the goal in 18 of 21 limbs with the unilateral frame and in 12 of 13 limbs using fixator-assisted plating. Operative time for fixator-assisted plating was longer (122 ± 34 minutes) than when using a unilateral frame (94 ± 65 minutes). Preoperative and postoperative knee ROMs were similar for both techniques and there were no major complications.

Conclusions

We obtained accurate correction of deformities with both fixation techniques. Our experience suggests the method to be used should be left to the discretion of the surgeon and the needs and wishes of the patient after adequate explanation of the advantages and disadvantages.

Level of Evidence

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

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Fig. 1A–C
Fig. 2A–D

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Acknowledgment

We thank Lindsey Schacter for assistance with data collection in this project.

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Authors and Affiliations

  1. Institute for Limb Lengthening and Complex Reconstruction, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    K. T. Matthew Seah BMedSci, MBChB, Raheel Shafi MD, Austin T. Fragomen MD & S. Robert Rozbruch MD

Authors
  1. K. T. Matthew Seah BMedSci, MBChB
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  2. Raheel Shafi MD
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  3. Austin T. Fragomen MD
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  4. S. Robert Rozbruch MD
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Corresponding author

Correspondence to S. Robert Rozbruch MD.

Additional information

The institution of the authors has received support from EBI/Biomet and Smith and Nephew Inc, but not directly for this study.

Each author certifies that his or her institution approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research

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Seah, K.T.M., Shafi, R., Fragomen, A.T. et al. Distal Femoral Osteotomy: Is Internal Fixation Better than External?. Clin Orthop Relat Res 469, 2003–2011 (2011). https://doi.org/10.1007/s11999-010-1755-0

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  • DOI: https://doi.org/10.1007/s11999-010-1755-0

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