Supracondylar opening osteotomy in distal femur in patient with genu valgum Report of two cases.
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Abstract
Introduction: Opening supracondylar varus osteotomy (OSCVO) to correct genu valgus has good results, but it has complications such as delayed union and nonunion due to internal cortex (hinge) fracture. The incidence of hinge fractures is high. This study aims to describe an additional procedure to the usual external OSCVO technique to prevent internal hinge fracture and report its functional results.
Methods: In two cases that were operated on at the Alcívar Hospital in April 2024, the genu was described as arthritic valgus, the supracondylar opening osteotomy technique was performed, a Steinmann nail and an Acutrak screw were used to fix the internal hinge, and a bench bone graft was placed to fill the opening, which was fixed with a plate. We performed pre- and postsurgical telemetry, assessing the functional results with the KSS scale.
Results: Both patients consulted for valgus deformity and osteoarthritis. In one case, the osteotomy was unicompartmental with pain, and in the other, it was tricompartmental without pain. Postsurgical mobilization was performed immediately. In one patient, the osteotomy consolidated within 2 months, initiating full weight bearing; in the other, it took 3 months.
Discussion: OSCVO has a 93–100% survival rate at 5 years and an 83.3% survival rate at 10 years. Lateral OSCVO is associated with a risk of internal hinge fracture (up to 48%) and, therefore, a higher rate of bone consolidation complications. When we perform an OVSA to correct the axis, the most significant concerns are planning the osteotomy site and preventing hinge fracture with additional percutaneous fixation. After 6 months of evolution, we obtained outstanding functional results.
Conclusions: When the OVSA and contralateral hinge protection were used, favorable results were obtained regarding the function and stability of the affected knee, which is an effective treatment for patients with symptomatic genu valgum.
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