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Objective <p>The optimal management of AO/OTA 33-C3 distal femoral fractures combined with symptomatic medial compartment knee osteoarthritis remains uncertain. This preliminary feasibility series explored whether metaphyseal comminution could be used as a “natural osteotomy” window to permit intentional valgus alignment correction during dual-plate fixation, while maintaining anatomical articular reconstruction and fracture stability.</p> Methods <p>This retrospective preliminary feasibility series included 17 patients with AO/OTA 33-C3 distal femoral fractures complicated by Kellgren-Lawrence grade 3 or 4 medial compartment knee osteoarthritis. All patients underwent anatomical reconstruction of the articular surface, intentional mild valgus alignment correction using the metaphyseal comminuted zone as a “natural osteotomy,” and medial–lateral dual-plate fixation. The primary feasibility outcomes included successful articular reconstruction, achievement and maintenance of planned valgus alignment, fracture union, and absence of early mechanical failure or reoperation. Operative time, intraoperative blood loss, articular step-off and gap, healing time, complications, mLDFA, and HKA angle were assessed. Pain, range of motion, Knee Society Score, and ambulatory status were evaluated as exploratory clinical outcomes.</p> Results <p>Mean operative time was 148.18 ± 10.01&#xa0;min and blood loss 351.18 ± 30.18&#xa0;mL. Anatomical articular reduction (step-off ≤ 2&#xa0;mm) was achieved in all patients, with mean step-off 0.97 ± 0.20&#xa0;mm and gap 0.98 ± 0.16&#xa0;mm. All fractures united (mean healing time 29.76 ± 3.42&#xa0;weeks), with no nonunion, implant failure, or reoperation within years. mLDFA changed from contralateral baseline 93.09° ± 0.65°to postoperative 85.03° ± 0.50°(<i>P</i> &lt; 0.001); HKA changed from varus –9.12° ± 1.41°to valgus 2.47° ± 0.80°(<i>P</i> &lt; 0.001). At final follow‑up, VAS pain score decreased from 7.47 ± 0.87 to 1.18 ± 0.39 (<i>P</i> &lt; 0.001). KSS knee score increased from 34.12 ± 3.64 to 89.76 ± 3.21 (<i>P</i> &lt; 0.001), and KSS function score from 43.82 ± 4.85 to 81.65 ± 2.80 (<i>P</i> &lt; 0.001). Mean maximum knee flexion was 99.29° ± 4.22°at final follow‑up. Independent ambulation was achieved in 16 patients (94.1%).</p> Conclusion <p>In this small single-center preliminary feasibility series, intentional valgus alignment correction using the metaphyseal comminuted zone as a “natural osteotomy” during dual-plate fixation was technically feasible in selected patients with AO/OTA 33-C3 distal femoral fractures and medial compartment knee osteoarthritis. This approach achieved fracture union, maintained coronal alignment, and showed favorable exploratory pain and functional outcomes at mid-term follow-up. These preliminary findings support this joint-preserving concept and warrant further validation in prospective comparative studies with longer follow-up.</p>

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Intentional valgus alignment correction using metaphyseal comminution as a “natural osteotomy” during dual-plate fixation for AO/OTA 33-C3 distal femoral fractures with medial knee osteoarthritis: a preliminary feasibility series

  • 期刊论文

  • 发表日期：

    2026年5月16日

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  • Shengrui Wang,
  • Jialan Zhao,
  • Xiao Wang,
  • Guorui Cao,
  • Xiaotao Shi,
  • Shangzeng Wang,
  • Honglue Tan

摘要

Objective

The optimal management of AO/OTA 33-C3 distal femoral fractures combined with symptomatic medial compartment knee osteoarthritis remains uncertain. This preliminary feasibility series explored whether metaphyseal comminution could be used as a “natural osteotomy” window to permit intentional valgus alignment correction during dual-plate fixation, while maintaining anatomical articular reconstruction and fracture stability.

Methods

This retrospective preliminary feasibility series included 17 patients with AO/OTA 33-C3 distal femoral fractures complicated by Kellgren-Lawrence grade 3 or 4 medial compartment knee osteoarthritis. All patients underwent anatomical reconstruction of the articular surface, intentional mild valgus alignment correction using the metaphyseal comminuted zone as a “natural osteotomy,” and medial–lateral dual-plate fixation. The primary feasibility outcomes included successful articular reconstruction, achievement and maintenance of planned valgus alignment, fracture union, and absence of early mechanical failure or reoperation. Operative time, intraoperative blood loss, articular step-off and gap, healing time, complications, mLDFA, and HKA angle were assessed. Pain, range of motion, Knee Society Score, and ambulatory status were evaluated as exploratory clinical outcomes.

Results

Mean operative time was 148.18 ± 10.01 min and blood loss 351.18 ± 30.18 mL. Anatomical articular reduction (step-off ≤ 2 mm) was achieved in all patients, with mean step-off 0.97 ± 0.20 mm and gap 0.98 ± 0.16 mm. All fractures united (mean healing time 29.76 ± 3.42 weeks), with no nonunion, implant failure, or reoperation within years. mLDFA changed from contralateral baseline 93.09° ± 0.65°to postoperative 85.03° ± 0.50°(P < 0.001); HKA changed from varus –9.12° ± 1.41°to valgus 2.47° ± 0.80°(P < 0.001). At final follow‑up, VAS pain score decreased from 7.47 ± 0.87 to 1.18 ± 0.39 (P < 0.001). KSS knee score increased from 34.12 ± 3.64 to 89.76 ± 3.21 (P < 0.001), and KSS function score from 43.82 ± 4.85 to 81.65 ± 2.80 (P < 0.001). Mean maximum knee flexion was 99.29° ± 4.22°at final follow‑up. Independent ambulation was achieved in 16 patients (94.1%).

Conclusion

In this small single-center preliminary feasibility series, intentional valgus alignment correction using the metaphyseal comminuted zone as a “natural osteotomy” during dual-plate fixation was technically feasible in selected patients with AO/OTA 33-C3 distal femoral fractures and medial compartment knee osteoarthritis. This approach achieved fracture union, maintained coronal alignment, and showed favorable exploratory pain and functional outcomes at mid-term follow-up. These preliminary findings support this joint-preserving concept and warrant further validation in prospective comparative studies with longer follow-up.