Supracondylar opening osteotomy in the distal femur for Genu Valgum. Percutaneous protection of the internal hinge. Presentation of 2 cases. Alcívar Hospital 2024.

Abstract

Introduction: Genu valgus is the alteration of the femorotibial axis beyond 6-8° of the physiological valgus and is characterized by a displacement of the load axis towards the lateral compartment. The opening supracondylar varicose osteotomy to correct genu valgum has good results but has complications such as delayed union and lack of union due to fracture of the internal cortex (hinge). The incidence of hinge fractures is high. Therefore, preventing it is essential to improve functional results and bone healing. Our work aims to describe an additional procedure to the usual technique of external opening supracondylar osteotomy to prevent fracture of the internal hinge and also report the functional results.

Methods: Two cases operated on at the Alcívar Hospital in April 2024 for presenting arthritic genu valgum are described. The supracondylar osteotomy technique of opening and use of a LISS plate was performed. To protect and fix the internal hinge, a Steinmann nail was used, and then an Acutrak conical screw.

Results: These two patients, for whom the additional internal hinge protection technique has been used, are currently 6 months postoperative. The osteotomy has been fully consolidated, and the functional assessment uses the American Knee Society Scale (KSS). They have values ​​greater than 85 points.

Conclusion: External opening varus osteotomy for a valgus knee should be performed with additional percutaneous fixation at the contralateral medial hinge site to provide excellent stability and rigidity to the osteotomy fixation system, avoid fracture of the hinge, promote rapid consolidation of the osteotomy and obtain better functional results.