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External Dynamic Self-Compressive Fixation in High Tibial Osteotomy

Author s : V. Stavrev, P. Stavrev, S. Dimov, B. Veleganov
Country: Bulgaria
E-mail: stavrevp@yahoo.com

Department of Orthopedics and Traumatology, Medical University , Plovdiv , Bulgaria

Aim
To share our experience with the use of own external self-compressive fixator in high tibial osteotomy. Hundreds of models of external fixators exist, but all without the ability for self-compression.

Material and Methods
In our department for 15 years on we use the invented by Jelev, Veleganov and Klinkov external fixator, modified for self-compression in accordance with the weight of the patient (Fig. 1).

The act of self-compression is accomplished during stepping of the patient. We analyze the results after operative treatment of 47 patients with goarthrosis on whom we performed high tibial Coventry osteotomy (Fig. 2).

Simultaneously we performed ventralization of the distal fragment in order to separate the patella from the femoral condyles. For fixation after osteotomy we applied our fixator. After the acute period on the 3-rd day the patients were allowed to load the extremity and after 8-10 days they were discharged.

Results

30-45 days after the operation the device was removed and the rehabilitation was continued at home. Out of the followed up 47 patients all were with varus deformity. In 31 patients bone healing was registered on 30-35 postoperative day and the fixator was removed. In the remaining 14 it was removed on the 45-th day (Fig. 3).

The average age of the patients was 56 years and out of them 31 were women and 16 - men. We did not have any case of non-union in our series.

Discussion

Nowadays in accordance with the advertising company of the AO Group, most authors report for their results after open wedge high tibial osteotomy for varus gonarthrosis 4 . To our belief the greater operative exposure, the necessity for bone autografting and the internal plate fixation, which imposes secondary operation for removal of the implant makes the medial open wedge osteotomy less effective than the original Coventry method 1,2,3 . The active immobilization via compressive external fixation device allows early mobilization of the extremity and the removal of the implant on the 45-th day is safe and easy, and can be performed under local anesthesia. The risk for pin track infection can be avoided with twice daily applications of Betadine solution to the entry points of the pins and antibiotic prophylaxis.

With the use of our device we avoided the internal fixation and thus the secondary operation for implants removal. In plaster immobilization after osteotomy extension stiffness of the knee joint is developed, which is very resistant to rehabilitation.

Conclusion

The obtained very good results after use of our external self-compressive device in high tibial osteotomies pushes us to apply it with priority, because besides fixation of the bone fragments it provides compression between them during walking, which leads to rapid calus formation and preservation of the knee function.

References

1. Veleganov S. Treatment of gonarthrosis with high wedge osteotomy of the tibia in varus or valgus deformity of the knee joint. PhD Thesis, 1990, Plovdiv , Bulgaria .
2. Veleganov S, Jelev J. Our experience with self compressive external fixator after high tibial osteotomy. Jubilee Scientific Session, 1984, Sofia , Bulgaria .
3. Jelev J, Veleganov S. Operative technique for one stage operative treatment of the femor-tibial and femor-patellar arthrosis. IV-th Joint Symposium of Sofia and Essen Universities , 30.06.1984, Sofia , Bulgaria .