Femoral Supracondylar Dome Osteotomy for Correction of Genu Valgum Deformity: Comparative Analysis of K-Wire Versus Plate Osteosynthesis

Abstract

Anshul Meena*, Manish Bajaj, Gaurav Jain

Background: Genu valgum deformity significantly impacts lower limb biomechanics and function. Dome osteotomy represents an effective corrective technique, but the optimal fixation method remains debated. This study compares outcomes of K-wire versus plate osteosynthesis for dome osteotomy fixation.

Methods: Prospective cohort study of 18 patients (22 knees) with symptomatic genu valgum undergoing femoral supracondylar dome osteotomy. Fixation was with either 4 K-wires (2 medial, 2 lateral; n=10 knees) or 3.5 mm locking compression plate (n=12 knees). K-wires were preferentially used in patients with comorbidities (renal rickets, hypophosphatemic rickets) to reduce operative time and blood loss. Preoperative and postoperative assessments included full-length scanograms, radiological analysis, and Bostman functional scores at 6 months follow-up.

Results: Both groups achieved excellent deformity correction with mean tibiofemoral angle reducing from 21.2° to 4.1° (p<0.0001). Union was achieved in all cases, though delayed union occurred in 3 knees (13.6%), all in the K-wire group. K-wire patients required 6-week immobilization versus 3-week immobilization in the plate group before active range of motion. Weight-bearing was initiated at 6-8 weeks in both groups. Complications included peroneal nerve paresis in 1 patient (recovered by 8 weeks), pin tract infections in 4 knees (4/10 K-wire cases, 40%), and superficial infection in 1 plate patient. Bostman scores were excellent or good in 100% of cases at 6 months. Scanogram measurements confirmed no limb length discrepancy in either group.

Conclusions: Dome osteotomy with either K-wire or plate fixation provides reliable correction of genu valgum with excellent functional outcomes. Plate fixation offers earlier active range of motion and reduced infection risk, making it preferable in uncomplicated cases. K-wire fixation remains a viable option for patients with comorbidities requiring operative time reduction, though pin tract infections necessitate rigorous wound care protocols.