Objective: The aim of this study was to evaluate the results of fixator assisted correction of the distal femoral valgus deformities and the precision of the correction. Methods: Seventeen extremities of 13 patients (7 women and 6 men; mean age: 16 ± 5.4 years) who had fixator assisted plating of the distal femur for genu valgum deformity were evaluated. Mechanical axis deviation (MAD) and mechanical lateral distal femoral angles (mLDFA) were measured pre-operatively and post-operatively. mLDFA was graded as perfect if it is between 85 and 90(85 x 90); overcorrection if it is between 91 and 95 (91 x 95) and undercorrection if it is between 80 and 85 (80 x < 85). Measurements beyond those limits were graded as a poor result. The position of the mechanical axis line with respect to center of the knee was graded from zone 1 to zone 4 pre-operatively and post-operatively. Results: The mean follow-up period was 12.8 ± 3.7 months. The pre-operative and post-operative mLDFA was 70.5±9.4 (range, 57e82) and 87.7 ± 3.5 (range, 80e94), respectively (p < 0.001). Based on post-operative standing radiographs, the correction was graded perfect in 12 femurs. The correction in three femurs were graded as overcorrection and graded as undercorrection in two femurs. Sagittal plane correction was also achieved in two femurs. Peroneal nerve decompression was done in three patients (5 extremities) with valgus deformity over 30. The mechanical axes in all lower extremities were passing through zone 2 or more, pre-operatively, whereas the mechanical axes were in zone 2 or more in five extremities post-operatively. Conclusion: Fixator assisted plating is an effective treatment modality in patients with distal femoral valgus deformity. Although the technique enables to obtain significant correction in coronal plane it has the disadvantages of over- and undercorrection. Thus, we advise intraoperative confirmation of the correction under fluoroscopic control.
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Janakiramanan N, Teichtahl AJ, Wluka AE, et al. Static knee alignment is associated with the risk of unicompartmental knee cartilage defects. Orthop Res. 2008 Feb;26(2):225e230.
Zhai G, Ding C, Cicuttini F, Jones G. A longitudinal study of the association between knee alignment and change in cartilage volume and chondral defects in a largely non-osteoarthritic population. J Rheumatol. 2007 Jan;34(1):181e186.
Tetsworth K, Paley D. Malalignment and degenerative arthropathy. Orthop Clin North Am. 1994;25(3):367e377.
Yilmaz G, Oto M, Thabet AM, et al. Correction of lower extremity angular deformities in skeletal dysplasia with hemiepiphysiodesis: a preliminary report. J Pediatr Orthop. 2014 Apr-May;34(3):336e345.
Oto M, Yılmaz G, Bowen JR, Thacker M, Kruse R. Adolescent Blount disease in obese children treated by eight-plate hemiepiphysiodesis. Eklem Hastalik Cerrahisi. 2012 Apr;23(1):20e24.
Paley D. Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop Relat Res. 1990 Jan;(250):81e104.
Bar-On E, Horesh Z, Katz K, et al. Correction of lower limb deformities in children with renal osteodystrophy by the Ilizarov method. J Pediatr Orthop. 2008;28(7):747e751.
Kocaoglu M, Eralp L, Bilen FE, Balci HI. Fixator-assisted acute femoral deformity correction and consecutive lengthening over an intramedullary nail. J Bone Joint Surg Am. 2009 Jan;91(1):152e159.
Eidelman M, Keren Y, Norman D. Correction of distal femoral valgus deformities in adolescents and young adults using minimally invasive fixatorassisted locking plating (FALP). J Pediatr Orthop B. 2012 Nov;21(6): 558e562.
Healy WL, Anglen JO, Wasilewsky SA, et al. Distal femoral varus osteotomy. J Bone Joint Surg Am. 1988;70(1):102e109.
McDermott PA, Finkelstein JA, Farine I, et al. Distal femoral varus osteotomy for valgus deformity of the knee. J Bone Joint Surg Am. 1988;70:110e116.
Miniaci A, Grossman SP. Jacob RP Supracondylar femoral varus osteotomy in the treatment of valgus knee deformity. Am J Knee Surg. 1990;3:65e73.
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):1348e1352.
Puddu G, Cipolla M, Cerullo G, Franco V, Giannì E. Which osteotomy for a valgus knee. Int Orthop. 2010 Feb;34(2):239e247.
Omidi-Khashani F, Hasankhani IG, Mazlumi M, Ebrahimzadeh MH. Varus distal femoral osteotomy in young adults with valgus knee. J Orthop Surg Res. 2009;13(4):4e15.
Stevens PM. Guided growth for angular correction: a preliminary series using a tension band plate. J Pediatr Orhop. 2007 Apr-May;27(3):253e259.
Cooper GA, Southorn T, Eastwood DM, Bache CE. Lower extremity deformity management in MPS IVA, morquio-Brailsford syndrome: preliminary report of hemiepiphysiodesis correction of genu valgum. J Pediatr Orthop. 2016 Jun;36(4):376e381.
Seah KT, Shafi R, Fragomen AT, Rozbruch SR. Distal femoral osteotomy: is internal fixation better than external? Clin Orthop Relat Res. 2011 Jul;469(7): 2003e2011.