Sidhu Gur Aziz Singh, Kaur Harjot, Mubark Islam, Alwadia Ahmed, Nagy Mohamed, Ashwood Neil
Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Burton, GBR.
Anaesthesia, Queen Elizabeth Hospital, London, GBR.
Cureus. 2022 Nov 14;14(11):e31500. doi: 10.7759/cureus.31500. eCollection 2022 Nov.
Coronal plane knee deformities are common disorders affecting adolescents. Valgus deformities (tibiofemoral angle (TFA) > 12-15 degrees and intermalleolar distance (IMD) > 10 cm) often require corrective osteotomy and a wedgeless "V" distal femoral osteotomy is a good treatment option for such deformities.
Thirty adolescent patients (13-17 years) with valgus deformities were included. Patients with severe collateral ligament instability, subluxation, and sagittal plane deformity > 15 degrees or genu valgum due to tibial deformity were excluded. Preoperative clinical (Bostman's knee score, IMD, and knee-flexion test) and radiological evaluations were done. The surgery (wedgeless distal femoral V osteotomy) was performed and stabilized with two Kirschner wires (K-wires). Postoperative clinical and radiological parameters were recorded including complications.
The preoperative TFA was 20.23 ± 3.63 degrees, which reduced to 5.5 ± 0.73 at six months postoperatively. The preoperative IMD was 12.45 ± 2.2 cm, which reduced to 1.63 ± 0.32 cm at six months. The mean mechanical axis deviation (MAD) and lateral distal femoral angle (LDFA) were recorded as 2.8 ± 0.39 and 87.7 ± 0.83, respectively, and the differences were statistically significant from preoperative values. The Bostman score was 26.2 ± 1.79 at three months and 29.47 ± 0.9 at six months. The complications included infection in two patients, a hypertrophic scar in one patient, and common peroneal neuropraxia in one patient.
Wedgeless distal femoral osteotomy with K-wire fixation is a viable option for correction of genu valgus deformity with potential advantages of minimal blood loss, no leg length discrepancy, non-rigid fixation, and early union as compared to other treatment options.
冠状面膝关节畸形是影响青少年的常见疾病。外翻畸形（胫股角（TFA）>12 - 15度且内踝间距（IMD）>10厘米）通常需要进行矫正截骨术，而无楔形“V”形股骨远端截骨术是治疗此类畸形的良好选择。
纳入30例患有外翻畸形的青少年患者（13 - 17岁）。排除严重侧副韧带不稳定、半脱位以及矢状面畸形>15度或因胫骨畸形导致的膝外翻患者。进行术前临床评估（博斯特曼膝关节评分、IMD和膝关节屈曲试验）及影像学评估。实施手术（无楔形股骨远端V形截骨术）并用两根克氏针固定。记录术后临床和影像学参数，包括并发症。
术前TFA为20.23±3.63度，术后6个月降至5.5±0.73度。术前IMD为12.45±2.2厘米，术后6个月降至1.63±0.32厘米。平均机械轴偏移（MAD）和股骨远端外侧角（LDFA）分别记录为2.8±0.39和87.7±0.83度，与术前值相比差异具有统计学意义。博斯特曼评分在术后3个月为26.2±1.79，术后6个月为29.47±0.9。并发症包括2例感染、1例肥厚性瘢痕和1例腓总神经失用症。
与其他治疗选择相比，克氏针固定的无楔形股骨远端截骨术是矫正膝外翻畸形的可行选择，具有失血少、无腿长差异、非刚性固定和早期愈合等潜在优势。
