Strategies in Trauma and Limb Reconstruction

Register      Login

VOLUME 15 , ISSUE 1 ( January-April, 2020 ) > List of Articles

Original Article

Accuracy and Safety of Distal Femoral Valgus Correction: A Comparison of Three Techniques

Christopher A Iobst, Mohammed Waseemuddin, Anirejuoritse Bafor

Citation Information : Iobst CA, Waseemuddin M, Bafor A. Accuracy and Safety of Distal Femoral Valgus Correction: A Comparison of Three Techniques. 2020; 15 (1):41-46.

DOI: 10.5005/jp-journals-10080-1455

License: CC BY-NC-SA 4.0

Published Online: 27-01-2021

Copyright Statement:  Copyright © 2020; The Author(s).


Introduction: There are several methods for correcting distal femoral valgus deformity in skeletally mature patients including fixator-assisted plating (FAP), fixator-assisted nailing (FAN) and nailing using the reverse planning method. The fixator-assisted techniques have been previously compared in the literature and found to be similarly accurate. This study is the first to compare all three procedures in a single series. Materials and methods: A retrospective review of patients who had undergone distal femoral valgus correction at a single institution between March 2017 and February 2020 was undertaken. Three different patient groups were identified based on the surgical technique used: the FAP, the FAN and the reverse planning method. The mechanical lateral distal fimoral angle (mLDFA) was recorded and compared preoperatively and postoperatively. The body mass index (BMI), duration of surgery, postoperative range of motion (ROM) and complication profile for each patient were also recorded and compared. Results: A total of 27 limbs in 24 patients were included in this study. There were 8 male and 16 female patients. There were 10 limbs from 9 patients in the reverse planning group, 11 limbs from 11 patients in the FAN group and 6 limbs from 4 patients in the FAP group. There was a statistically significant difference in the mean preoperative and postoperative mLDFA for each of the individual groups (p < 0.0001 for each group). All patients had restoration of the mLDFA to within normal limits except one patient in the reverse planning group. This was purposefully performed to compensate for an ipsilateral proximal tibial deformity. There was no statistically significant difference in the mean preoperative and postoperative mLDFA across the groups (p = 0.2897 and 0.3440, respectively). The operative time of the reverse planning method and the FAP were significantly shorter than FAN (p = 0.0016 and p = 0.0035, respectively). The mean final knee ROM amongst the groups was similar (p = 0.8190). We recorded no infections or union complications in any group. There was one case of hardware irritation causing lateral knee pain that did not require treatment in the reverse planning group and one fracture through a temporary half-pin site in the FAN group. All six plates in the FAP group had to be removed following union on account of localised discomfort from the hardware. Conclusion: The reverse planning method, the FAN and the FAP are comparable in terms of accuracy in achieving correction of distal femur valgus deformity in skeletally mature patients. The reverse planning method had the best combination of outcomes in this study since it was just as accurate as the FAN and the FAP techniques and did not require any additional surgeries. While both the reverse planning and the FAP were faster than the FAN technique, the reverse planning method allows the ability to perform both deformity correction and lengthening. Ultimately, the decision of which technique to use depends on a combination of the patient's preference and the surgeon's level of comfort with the technique.

  1. Sharma L, Song J, Felson DT, et al. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA 2001;286(2):188–195. DOI: 10.1001/jama.286.2.188.
  2. Sculco PK, Kahlenberg CA, Fragomen AT, et al. Management of extra-articular deformity in the setting of total knee arthroplasty. J Am Acad Orthop Surg 2019;27(18):e819–e830. DOI: 10.5435/JAAOS-D-18-00361.
  3. Marangoz S, Feldman DS, Sala DA, et al. Femoral deformity correction in children and young adults using Taylor spatial frame. Clin Orthop Rel Res 2008;466(12):3018–3024. DOI: 10.1007/s11999-008-0490-2.
  4. Want JW, Hsu CC. Distal femoral varus osteotomy for osteoarthritis of the knee. J Bone Joint Surg Am 2005;87(1):127–133. DOI: 10.2106/JBJS.C.01559.
  5. Seah KT, Shafi R, Fragomen AT, et al. Distal femoral osteotomy: is internal fixation better than external? Clin Orthop Relat Res 2011;469(7):2003–2011. DOI: 10.1007/s11999-010-1755-0.
  6. Eidelman M, Keren Y, Norman D. Correction of distal femoral valgus deformities in adolescents and young adults using minimally invasive fixator-assisted locking plating (FALP). J Pediatr Orthop B 2012;21(6):558–562. DOI: 10.1097/BPB.0b013e328358f884.
  7. Rozbruch SR. Fixator-assisted plating of limb deformities. Oper Tech Orthop 2011;21(2):174–179. DOI: 10.1053/j.oto.2011.01.005.
  8. Yilmaz G, Bakircioglu S. Correction of distal femoral valgus deformities with fixator-assisted plating: how accurate is the correction? Acta Orthop Traumatol Turc 2019;53(2):100–105. DOI: 10.1016/j.aott.2018.11.002.
  9. Paley D, Herzenberg JE, Bor N. Fixator-assisted nailing of femoral and tibial deformities. Tech Orthop 1997;12(4):260–275. DOI: 10.1097/00013611-199712000-00004.
  10. Kocaoglu M, Bilen FE. Fixator-assisted nailing for correction of long bone deformities. Operat Tech Orthop 2011;21(2):163–173. DOI: 10.1053/j.oto.2011.01.010.
  11. Kocaoglu M, Eralp L, Bilen FE, et al. Fixator-assisted acute femoral deformity correction and consecutive lengthening over an intramedullary nail. J Bone Joint Surg Am 2009;91(1):152–159. DOI: 10.2106/JBJS.H.00114.
  12. Eralp L, Kocaoglu M, Toker B, et al. Comparison of fixator-assisted nailing versus circular external fixator for bone realignment of lower extremity in rickets. Arch Orthop Trauma Surg 2011;131(5):581–589. DOI: 10.1007/s00402-010-1162-8.
  13. Fragomen AT, Rozbruch SR. Retrograde magnetic internal lengthening nail for acute femoral deformity correction and gradual limb lengthening. Expert Rev Med Devices 2017;14(10):811–820. DOI: 10.1080/17434440.2017.1378092.
  14. Iobst CA, Rozbruck SR, Nelson S, et al. Simultaneous acute femoral deformity correction and gradual lim lengthening using a retrograde femoral nail: Technique and clinical results. J Am Acad Orthop Surg 2018;26(7):241–250. DOI: 10.5435/JAAOS-D-16-00573.
  15. Galal S. Comparison of fixator-assisted plating versus fixator-assisted nailing for distal femoral osteotomy. J Limb Lengthening Reconstr 2017;3(1):52–56. DOI: 10.4103/jllr.jllr_25_16.
  16. Kovar FM, Jauregui JJ, Herzenberg JE. Accuracy of distal femoral valgus deformity correction: fixator-assisted nailing versus fixator-assisted locked plating. Am J Orthop 2018;47(6). DOI: 10.12788/ajo.2018.0044.
  17. Baumgart R. The reverse planning method for lengthening of the lower limb using a straight intramedullary nail with or without deformity correction. Oper Orthop Traumatol 2009;21(2):221–233. DOI: 10.1007/s00064-009-1709-4.
  18. Kucukkaya M, Sokucu S, Thaller PH. Surgical techniques for lengthening and deformity correction of the femur with lengthening nails. Tech Orthop 2015;30(3):183–188. DOI: 10.1097/BTO.0000000000000137.
  19. Lenze U, Krieg AH. Intramedullary lengthening nails: Can we also correct deformities? J Child Orthop 2016;10(6):511–516. DOI: 10.1007/s11832-016-0782-0.
  20. Paley D. Normal lower limb alignment and joint orientation. In: Principles of Deformity Correction 2002. 1–18.
  21. Hung AL-H, McClure PK, Franzone JM, et al. Bone ninja mobile app for reverse planning method in internal limb deformity and lengthening surgery. Strategies in Trauma and Limb Reconstruction 2019;14(2):72–76. DOI: 10.5005/jp-journals-10080-1425.
  22. Kearney SP, Mosca VS. Selective hemiepiphyseodesis for patellar instability with associated genu valgum. J Orthop 2015;12(1):17–22. DOI: 10.1016/j.jor.2015.01.005.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.