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Minimally Invasive Plate Osteosynthesis for Tibial Derotation Osteotomy

March 01, 2017

Contributors: Ilker Abdullah Sarikaya, MD; Ozan Ali Erdal, MD; Muharrem Inan, MD

Indications for a tibial derotation osteotomy are thigh-foot angle of more than 20 degrees of internal rotation or more than 40 degrees of external rotation in ambulatory children. The only contraindication for derotation osteotomy is known active infection at or near the site of osteotomy. Step 1 Skin Incision: With the patient at supine position, distal tibial physis is marked along with anterior and posterior margins of the bone. If needed physis can be marked under fluoroscopic view. On the medial side of distal tibia, a longitudinal 3 cm long skin incision is done, starting 1 or 2 cm proximal to the distal physis. Incision should be located at the middle of the bone. After subcutaneous dissection, the periosteum is reached. It is incised longitudinally and subperiosteal dissection is performed at the site of metaphyseal-diaphyseal junction, where the osteotomy is planned. Step 2 Osteotomy: On the transvers plane, multiple drill holes are made with a 2.7 mm drill using 2.7 mm drill guide. Drill holes are made circumferentially throughout the tibial cortex on the same plane. Later, with an osteotome, drill holes are united and osteoclasis is completed. Step 3 Rotational Maneuver: A titanium 3.5 or 4.5 mm locking plate is placed from the incision and advanced proximally at submuscular level. We chose a 3.5 mm locking plate in this case. Planned position of the plate is tried on under fluoroscopic control. Distal tibial fragment is rotated in the direction of desired correction. The amount of correction is decided according to clinical examination in the operation room. The aim is to give neutral rotational alignment to the distal tibia. Step 4 Fixation of Osteotomy: In order to secure the plate on the bone a distal screw is applied initially. Drilling is performed with the help of a 2.7 mm sleeve. After measuring the screw size a 4 mm cancellous screw is applied. The proximal screw holes are easily found by palpation and their positions are marked on the skin. A thin K wire is placed easily through the skin into the most proximal screw hole. The position of the wire is controlled under fluoroscopy. Touching the wire, a stab incision is made just over the hole. A 2.7 mm sleeve is driven over the wire and locked on the plate. K wire is removed. The bone is drilled with a 3.5 mm drill through the sleeve. After measuring the required screw length, a 3.5 mm cortical screw is applied. After this point, position of both the plate and the osteotomy site should be checked again. Proximal cortical screws are placed with the same percutaneous fashion, after the distal cancellous screws are put through the incision. Plaster cast or any other forms of immobilization are unnecessary. Early weight bearing and full range of motion exercises are allowed. Preoperative and postoperative clinical examinations of the patient are presented here. The amount of correction is easily noticed. Here we present the preoperative and postoperative radiographies of the patient. We conducted a study involving analysis of the results after minimally invasive osteosynthesis for tibial derotation osteotomy. In this study 16 children with cerebral palsy underwent the procedure. Patients were operated in 2013 and 2014. The average age of the children at the time of surgery was 11.5 years old. During follow up all patients had complete consolidation at the osteotomy site. None of our patients experienced any infection or loss of fixation. Only complication in one of our patients was a mild wound detachment. It was treated with local wound care and healed well.

Results for "Complications"