Axial and torsional stability of supracondylar femur osteotomies: biomechanical comparison of the stability of five different plate and osteotomy configurations

Little is known regarding the biomechanical stability and stiffness of implants and techniques used in supracondylar femur osteotomies (SCO). Therefore, fixation stability and stiffness of implants to bone was investigated under simulated physiological loading conditions using a composite femur model and a 3D motion-analysis system. Five osteotomy configurations were investigated: (1) oblique medial closing-wedge fixated with an angle-stable implant; (2) oblique and (3) perpendicular medial closing-wedge, both fixated with an angled blade plate; and lateral opening-wedge fixated with (4) a spacer plate and (5) an angle-stable lateral implant. The motion measured at the osteotomy was used to calculate the stiffness and stability of the constructs. The least amount of motion and highest stiffness was measured in the medial oblique closing-wedge osteotomy fixated with the angled blade plate. The lateral opening-wedge techniques were less stable and had a lower stiffness compared with the medial; the oblique saw cuts were more stable and had a higher stiffness than the perpendicular. This experimental study presents baseline data on the differences in the primary stability of bone-implant constructs used in SCO. The data in this study can be used as reference for future testing of SCO techniques. Furthermore, it is recommended that based on the differences found, the early postoperative rehabilitation protocol is tailored to the stability and stiffness of the fixation method used.