Nonunion and Delayed Union in Lateral Open Wedge Distal Femoral Osteotomies-a Legitimate Concern?

Overview

Journal Int Orthop

Specialty Orthopedics

Date 2017 May 24

PMID 28534192

Citations 19

Authors

Franz Liska

Andreas Voss

Florian B Imhoff

Lukas Willinger

Andreas B Imhoff

Affiliations

Soon will be listed here.

Abstract

Introduction: Due to a supposed high rate of nonunions in lateral open wedge distal femur osteotomy (LOWDFO), the medial closing wedge technique has been favoured for a long time. The aim of this study was to report the occurrence of delayed- and nonunions following LOWDFO. We hypothesized that the occurrence of nonunions needing revision surgery is comparable to medial closing osteotomies.

Methods: Forty-one patients were treated with LOWDFO with a minimum follow-up of 12 months. Parameters such as age, gender, body mass index, valgus angle, the heights of the opening wedge, as well as the type of osteotomy (biplane vs single plane) were collected. Delayed union and nonunion were evaluated on radiographs along with clinical symptoms.

Results: The study group consisted of 21 females and 20 males, with a median age of 37 years at the time of surgery. Removal of hardware was performed in 63% after 1.3 years (0.6-2.1 years). The median preoperative valgus angle was 6.1° valgus (range 2-15.5°). The heights of the opening wedge ranged from 2 to 12 mm (mean 5.3 mm). Hinge fracture of the medial cortex was seen in 39%. Three patients had a delayed union, and one patient had a nonunion requiring revision surgery.

Conclusion: LOWDFO is a safe alternative to MCWDFO. Although radiolucency of the osteotomy gap can be evident on radiographs even after 12 months, this does not reflect the clinical finding. The nonunion rate is proven to be low and comparable with the nonunion rates of MCWDFOs as well as open wedge HTOs.

Citing Articles

Small changes of femoral torsion in varus or valgus distal femoral osteotomy using patient-specific instruments.

Jud L, Neopoulos G, Hodel S, Vlachopoulos L, Fucentese S Int Orthop. 2025; 49(3):621-627.

PMID: 39875640 PMC: 11889048. DOI: 10.1007/s00264-025-06415-5.

Radiographic Assessment of Bone Union in Proximal Tibia and Distal Femur Osteotomies: A Systematic Review.

Bax E, Harlianto N, Custers R, van Egmond N, Foppen W, Kruyt M JB JS Open Access. 2024; 9(4).

PMID: 39534655 PMC: 11557090. DOI: 10.2106/JBJS.OA.24.00101.

[Single-cut derotational osteotomy of the distal femur for correction of torsion and frontal axis].

Imhoff F, Trierweiler M Oper Orthop Traumatol. 2024; 36(2):96-104.

PMID: 38536427 PMC: 11014875. DOI: 10.1007/s00064-024-00844-y.

Impact of support instruments in medial closed-wedge distal femoral osteotomy: a finite element analysis.

Kuwashima U, Itoh M, Itou J, Okazaki K Arch Orthop Trauma Surg. 2023; 144(3):1039-1045.

PMID: 38110736 DOI: 10.1007/s00402-023-05152-x.

Additional Plate Fixation of Hinge Fractures After Varisation Distal Femoral Osteotomies Provides Favorable Torsional Stability: A Biomechanical Study.

Peez C, Grosse-Allermann A, Deichsel A, Raschke M, Glasbrenner J, Briese T Am J Sports Med. 2023; 51(14):3732-3741.

PMID: 37936394 PMC: 10691291. DOI: 10.1177/03635465231206947.

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