The use of the reconstruction plate in multiplanar tibial osteotomies in children

Abstract

External fixation and cross-pin fixation appear to be the two most commonly used forms of fixation after a tibial osteotomy in children described in the literature. The purpose of this study is to describe our experience using a properly bent and contoured reconstruction plate for mismatched surfaces after a multiplanar tibial osteotomy. A retrospective review was conducted of 37 multiplanar tibial osteotomy surgeries in 23 children performed by a single surgeon using a reconstruction plate for internal fixation. A low fibular osteotomy and tibial osteotomy that required contouring and shaping of the plate were performed in all cases. A proximal tibial osteotomy was performed in 30 cases and a distal osteotomy in seven cases. All cases were reinforced with a long-leg cast. All charts were reviewed for intra- and postoperative complications. The surgery using the reconstruction plate internal fixation was considered to be a success if there was healing of the osteotomy and no hardware failure. A properly bent and contoured reconstruction plate conformed well to the mismatched surfaces after tibial osteotomy. Hardware was removed in all but two cases, on average 7months after surgery. There were no hardware failures. No child developed a deep wound infection or neurovascular complication, including compartment syndrome. Only two complications in 37 surgeries (5%) were encountered and were typical of any type of internal fixation. One child required an exploratory procedure because of screw extrusion and one child developed a post-plate removal fracture. The reconstruction plate is very malleable and can be contoured to fit in nearly every direction to accommodate mismatched appositional surfaces. It has been successfully employed in 37 consecutive cases of multiplanar tibial osteotomy in children with relatively few complications, none directly related to the plate.