title: A reciprocating ledge technique in closing wedge osteotomy for genu valgum in adolescents.
abstract: OBJECTIVE
  To describe a technique that preserves anterior and posterior alternate ledges in a closing wedge osteotomy.
  
  
  METHODS
  Five patients aged 14 to 19 years underwent a closing wedge osteotomy for genu valgum in 8 limbs using a reciprocating ledge technique. A unicortical wedge of bone was removed, with the anterior and posterior cortices spared. The anterior cortex at the proximal level and the posterior cortex at the distal level were cut through. With a wobbling action, the osteotomy site was rotated, and the distal fragment externally rotated. Manual force was applied to close the osteotomy site ensuring overlapping of the reciprocal ledges. The distal fragment was translated laterally to prevent club deformity. The osteotomy site was held with one or 2 staples. Stability was tested by flexion and extension of knee.
  
  
  RESULTS
  All 8 limbs attained bone union within 12 weeks, and full range of motion within a mean of 13 (range, 12-15) weeks. The mean correction of the tibiofemoral angle was 13 degrees. At a mean follow-up of 12 months, all patients were pain-free and none developed club deformity.
  
  
  CONCLUSIONS
  Sparing reciprocal ledges in a closing wedge osteotomy for genu valgum may increase stability in the flexion-extension axis, enable early range-of-motion exercises, and facilitate early bone union.
authors.affiliation: The Government Hospital for Bone and Joint Surgery, Bagat Barzullah, Srinagar, Kashmir, India. shabirdhar@yahoo.com
authors.forename: Shabir Ahmed
authors.initials: SA
authors.lastname: Dhar
authors.forename: Mohammed Farooq
authors.initials: MF
authors.lastname: Butt
authors.forename: Mohammed Ramzan
authors.initials: MR
authors.lastname: Mir
authors.forename: Tahir Ahmed
authors.initials: TA
authors.lastname: Dar
authors.forename: Asif
authors.initials: A
authors.lastname: Sultan
mesh_terms: D000293:Adolescent; D005260:Female; D056304:Genu Valgum / Q000601:surgery*; D006801:Humans; D008297:Male; D010027:Osteotomy / Q000379:methods*; D017792:Surgical Stapling; D016896:Treatment Outcome; D055815:Young Adult