title: Distal femoral osteotomy: is internal fixation better than external?
abstract: BACKGROUND
  Distal femoral osteotomies (DFO) can be used to correct deformities around the knee. Although osteotomies can be fixed with either internal or external fixation techniques, the advantages of one over the other are unclear.
  
  
  OBJECTIVE
  We asked whether (1) for both techniques, we could accurately correct the deformities based on our preoperative goals for mechanical axis deviation (MAD) and lateral distal femoral angle (LDFA), and (2) intraoperative times, (3) preoperative and postoperative knee ROM, and (4) complications differed.
  
  
  METHODS
  We identified 26 patients (34 limbs) who underwent femoral osteotomies. We compared accuracy of correction (based on correction of the MAD and the LDFA), duration of surgery, preoperative and postoperative knee ROM, and complications. The minimum followup was 20 months (mean, 29 months; range, 20-40 months).
  
  
  RESULTS
  We achieved the desired MAD within 10 mm of the goal in 18 of 21 limbs with the unilateral frame and in 12 of 13 limbs using fixator-assisted plating. Operative time for fixator-assisted plating was longer (122 ± 34 minutes) than when using a unilateral frame (94 ± 65 minutes). Preoperative and postoperative knee ROMs were similar for both techniques and there were no major complications.
  
  
  CONCLUSIONS
  We obtained accurate correction of deformities with both fixation techniques. Our experience suggests the method to be used should be left to the discretion of the surgeon and the needs and wishes of the patient after adequate explanation of the advantages and disadvantages.
  
  
  METHODS
  Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Institute for Limb Lengthening and Complex Reconstruction, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
authors.forename: K T Matthew
authors.initials: KT
authors.lastname: Seah
authors.forename: Raheel
authors.initials: R
authors.lastname: Shafi
authors.forename: Austin T
authors.initials: AT
authors.lastname: Fragomen
authors.forename: S Robert
authors.initials: SR
authors.lastname: Rozbruch
mesh_terms: D000328:Adult; D016267:External Fixators; D005260:Female; D005269:Femur / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing; D006801:Humans; D007432:Intraoperative Period; D016916:Joint Deformities, Acquired / Q000601:surgery; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D010027:Osteotomy / Q000379:methods*; D011183:Postoperative Complications; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors