Navneet Rustagi1, Altaf Hussain2. 1. Department of Orthopaedics, Bhagwan Mahavir Hospital, Govt of NCT of Delhi, New Delhi, India. 2. Department of Orthopaedics, Teerthanker Mahaveer Medical College & Research Centre, Moradabad, Uttar Pradesh, India.
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 Böstman 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.
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 Böstman 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.