Orthopedics Today, May 2017
Distal femoral extension osteotomies, often times combined with patellar tendon advancement, are often used for the treatment of persistent crouch gait in adolescents and young adults with CP. These osteotomies are typically stabilized with internal fixation devices, such as a blade or locking compression plate to maintain reduction, decrease immobilization and promote early weight-bearing.
While there are no reported outcome studies regarding elective implant removal after extension osteotomy, Stout and colleagues, in their review of 73 patients with CP undergoing surgical treatment for knee flexion contractures, reported that in the 49 patients who underwent distal femoral osteotomy using a 90° blade plate, there were no hardware-related complications and the plates were not removed. Rutz and colleagues showed of 38 patients undergoing 63 distal femoral extension osteotomies, there was one implant-related complication (locking screw loosening 6 weeks postoperatively). They routinely removed the plates in 94% of patients for unspecified reasons.