A comparison of plate versus staple-and-cast fixation in maintaining femoral tibial alignment after valgus tibial osteotomy.
OBJECTIVE
To compare 2 methods of fixation for maintenance of alignment during healing of valgus tibial osteotomies.


METHODS
We performed a retrospective chart and radiographic review of valgus tibial osteotomy cases of staple fixation supplemented by a postoperative cast and of blade plate fixation for maintenance of femoral-tibial alignment during healing of the osteotomy.


RESULTS
Both groups (staple-and-cast, n = 16; plate, n = 28) were similar in terms of age, preoperative alignment, extent of osteoarthritis and degree of intra-operative correction. Between-group differences in the maintenance of femoral-tibial alignment during healing were not significant. In both groups there was a strong correlation between degree of bone contact at the osteotomy site and maintenance of alignment (p < 0.005). In cases done with the plate, 90% of osteotomies with good or excellent bone contact maintained alignment during healing; with poor or fair bone contact, 75% had loss of alignment > 5 degrees during healing. There was a trend toward a greater incidence of delayed or non-union with plate fixation compared with staple fixation that did not reach statistical significance. All of these cases of delayed/non-union had loss of femoral-tibial alignment > 5 degrees during healing.


CONCLUSIONS
As a result of this study, we have modified our surgical technique. We now use intra-operative fluoroscopy for optimization of bone contact, and we have reverted to the less invasive staple method for fixation of tibial osteotomies.
Harrison
Mark M
MM
Human Mobility Research Centre, Queen's University, Kingston, Ont. mmh2@post.queensu.ca
Waddell
James P
JP
D000328:Adult; D000368:Aged; D001860:Bone Plates; D002370:Casts, Surgical; D005260:Female; D005269:Femur / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D016268:Internal Fixators; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000503:physiopathology / Q000601:surgery*; D010027:Osteotomy; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013528:Surgical Staplers; D013977:Tibia / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome